THEORIES OF COUNSELING

Behavior Therapy: B.F. Skinner / Albert Bandura / Arnold Lazarus

INTRODUCTION Self-efficacy – Individual’s belief or expectation that he

• 1960s can master a situation and bring about desired change.
Albert Bandura developed social learning theory.
Example: Ways people can develop effective social
Cognitive behavioral approaches sprang up which skills after they are in contact with other people who
focus on cognitive representations of the environment effectively model interpersonal skills.
rather than on characteristics of the objective
environment. 4. Cognitive Behavior Therapy
What people believe influences how they act and feel.
• 1970s
Contemporary behavior therapy emerged as a major VIEW OF HUMAN NATURE
force in psychology. • Person is the producer and the product of his
environment.
Behavioral techniques were expanded to provide
solutions for business, industry and child-rearing • Current trend in behavior therapy - developing
problems. procedures that give control to clients and increase
their range of freedom.
Behavior therapy techniques viewed as the treatment
of choice for many psychological problems. 7 BASIC CHARACTERISTICS AND ASSUMPTIONS
1. Behavioral concepts and procedures are stated
• 1980s explicitly, tested empirically within a conceptual
Continued emergence of CBT as major force; framework and revised continually.

Application of behavioral techniques to the prevention ✓ Based on principles and procedures of scientific
and treatment of health-related disorders. method.
✓ Behavioral practitioners are systematically adhere
• 1990s to precision and to empirical evaluation.
The Association for Behavioral and Cognitive ✓ Evaluation methods are used to discern the
Therapies claimed a membership about 4,500. effectiveness of both assessment and treatment
procedures.
• 2000s
Third wave of behavior therapy - Dialectical Behavior 2. Behavior is not limited to overt actions a person
Therapy, Mindfulness-Based Stress Reduction, engages in that we can observe.
Mindfulness Based Cognitive Therapy, and
Acceptance and Commitment Therapy. ✓ Behavior includes internal processes such as
cognitions, beliefs, and emotions.
FOUR AREAS OF DEVELOPMENT ✓ Key characteristics of a behavior is that it is
1. Classical Conditioning – Ivan Pavlov something that can be operationally defined.
What happens prior to learning creates a response
through pairing. 3. Behavior therapy focuses on specific factors that
influence present functioning and what factors can be
Systematic Desensitization – procedure based on used to modify performance.
classical conditioning
✓ Functional assessment / Behavioral Analysis
2. Operant Conditioning – B.F. Skinner Helping client produce behavior change by
Behavior are influenced mainly by the consequences changing environmental events.
that follow them.
4. Clients are required to do something to bring about
3. Social Cognitive Theory – Albert Bandura change.
Triadic reciprocal interaction among the environment,
personal factors, and individual behavior. ✓ Clients monitor their behaviors both during and
outside the therapy sessions.
People are capable of self-directed behavior change ✓ Therapeutic tasks or homework assignments are
and that the person is the agent of change. basic part of this approach.
✓ Learning is viewed as being at the core of therapy.
BEHAVIOR THERAPY | 1
 THEORIES OF COUNSELING
Behavior Therapy: B.F. Skinner / Albert Bandura / Arnold Lazarus

5. The approach assumes change can take place without With a client who has trouble going to sleep,
insight into underlying dynamics and without listening to a relaxation tape may serve as a cue
understanding the origins of a psychological problem. for sleep induction.

6. Assessment informs the treatment process. ✓ Consequences are events that maintain a
behavior in some way, either by increasing or
✓ Therapists also assess their clients’ cultures as decreasing it.
part of their social environments.
Sample:
7. Behavioral treatment interventions are individually Client may be more likely to return to counseling
tailored to specific problems experienced by the client. after the counselor offers verbal praise or
encouragement for having come in or for having
✓ “What treatment, by whom, is the most effective for completed some homework. (increased)
this individual with that problem and under which
set of circumstances?” Client may be less likely to return if the counselor
is consistently late to sessions. (decreased)
THERAPEUTIC GOALS
✓ Goal: Increase personal choice and to create new ✓ Behavioral Assessment Interview
conditions for learning. Therapist’s task is to identify the particular antecedent
and consequent events that influence an individual’s
✓ Client, with the help of therapist, defines specific behavior.
treatment goals at the outset of the therapeutic
process. ✓ Other Role of Behavioral clinicians
✓ Formulates initial treatment goals and designs and
✓ A formal assessment takes place prior to treatment to implements a treatment plan to accomplish goals.
determine behaviors that are targets of change. ✓ Use strategies that have research support
✓ Evaluates the success of the change plan by
✓ Goals must be clear, concrete, understood, and agreed measuring progress toward the goals throughout
upon by the client and counselor. the duration of treatment.
✓ Conduct follow-up assessments to see whether the
✓ The process of determining therapeutic goals entails a changes are durable over time.
negotiation between client and counselor that results in
a contract that guides the course of therapy. CLIENT’S EXPERIENCE IN THERAPY
✓ Client engages in behavioral rehearsal with
✓ Both alter goals throughout the therapeutic process as feedback until skills are well learned and generally
needed. receives active homework assignments
✓ Need to be motivated to change and expected to
THERAPIST’S FUNCTION AND ROLE cooperate in therapeutic activities.
✓ Functional Assessment (Behavioral Analysis)
identify the maintaining conditions by systematically Motivational Interviewing – involves honoring the
gathering information about situational antecedents, client’s resistance in a way his motivation to
the dimensions of the problem behavior, and the change is increased over time (in case clients are
consequences of the problems. not motivated)

Goal of functional assessment of clients’ behavior is to ✓ Need to be willing to make changes and continue
understand ABC sequence implementing new behavior once formal treatment
has ended.
✓ ABC Model
Suggests that behavior (B) is influenced by some RELATIONSHIP BETWEEN THERAPIST AND CLIENT
events that precede it called antecedents (A), and by • Collaborative working relationship
certain events that follow it called consequences (C). • The client – therapist relationship is a foundation on
which therapeutic strategies are built to help clients
✓ Antecedents events cue or elicit a certain change in the direction they wish.
behavior.

Sample:
BEHAVIOR THERAPY | 2
 THEORIES OF COUNSELING
Behavior Therapy: B.F. Skinner / Albert Bandura / Arnold Lazarus

THERAPEUTIC TECHNIQUES AND PROCEDURES 5. Negative Punishment

A. Applied Behavioral Analysis: Operant Conditioning A reinforcing stimulus is removed following the
Techniques behavior to decrease the frequency of a target
• Offers a functional approach to understanding client’s behavior
problems and addresses these problems by changing
antecedents and consequences (ABC Model) Sample:
Deducting money from a worker’s salary for missing
• Use the least aversive means possible to change time at work
behavior
B. Progressive Muscle Relaxation
• Positive reinforcement – most powerful change agent • Used to cope with the stresses produced by daily living
by achieving muscle and mental relaxation
• Punishment should be used only after non-aversive
approaches have been implemented and found to be • Combined with a number of other behavioral
ineffective. techniques

• Goal of reinforcement: Increase the target behavior • Clients are given a set of instructions that teaches them
to relax.
1. Positive Reinforcement
Addition of something of value to the individual (praise, • Clients are instructed to actually feel and experience
attention, money, food) as a consequence of certain the tension building up, to notice their muscles getting
behavior tighter and study this tension, and to hold and fully
experience the tension.
2. Negative Reinforcement
✓ Escape from or the avoidance of aversive stimuli. • Most common use for:
✓ The individual is motivated to exhibit a desired ✓ Preparing for surgery
behavior to avoid the unpleasant condition. ✓ Cope with chronic pain
✓ Reducing the frequency of migraine attacks
3. Extinction ✓ Asthma
✓ Withholding reinforcement from a previously ✓ Irritable bowel syndrome
reinforced response. ✓ Panic disorder
✓ Negative side effects: anger and aggression
✓ Most often used in behavior modification programs C. Systematic Desensitization
in conjunction with various reinforcement • Based on principle of classical conditioning
strategies
✓ Dealing with problematic behavior is to eliminate • Clearly effective and efficient in reducing maladaptive
the connection between a certain behavior and a anxiety and treating anxiety – related disorder like
positive reinforcement. specific phobias

Sample: • Clients imagine more anxiety-arousing situations at the

A parent uses extinction when during and after a same time that they engage in a behavior that
child’s temper tantrum, the parent ignores the competes with anxiety
child’s tantrum – related behaviors.
• Goal of punishment: Decrease target behavior • Clients become less sensitive to anxiety-arousing
situation
4. Positive Punishment
Aversive stimulus added after the behavior to decrease • Can be considered a form of exposure therapy
the frequency of a behavior because clients are required to expose themselves to
reduce anxiety.
Sample:
Time-out procedure with a child who is displaying • If the decision is made to use the desensitization
misbehavior procedure, the therapist gives the client a rationale for
the procedure and describes what is involved.

BEHAVIOR THERAPY | 3
 THEORIES OF COUNSELING
Behavior Therapy: B.F. Skinner / Albert Bandura / Arnold Lazarus

• 3 – step process of Desensitization procedure E. Eye Movement Desensitization and Reprocessing

1. Relaxation Training • Form of exposure therapy
✓ Clients is asked to create imagery of previously
relaxing situations. • Entails assessment and preparation, imaginal
✓ Client must reach a state of calm and flooding, and cognitive restructuring in treating
peacefulness traumatic memories.
✓ Client is instructed to practice relaxation both as
a part of the desensitization procedure and also • Treatment involves the use of rapid, rhythmic eye
outside the session on a daily basis movements and other bilateral stimulation

2. Anxiety Hierarchy F. Social Skills Training

✓ Therapist constructs a ranked list of situations 1. Beneficial for individuals with psychosocial problems
that elicit increasing degrees of anxiety. partly caused by interpersonal difficulties
✓ The hierarchy is arranged in order from the most
to least provoking anxiety 1. Assertion Training
Teaching people how to be assertive
Sample:
Highest anxiety – producing situation might be Useful for those:
rejection by the spouse, next, rejection by a close ✓ difficulty expressing anger or irritation
friend and then rejection by a coworker. ✓ difficulty saying no
✓ overly polite and allow others to take
3. Desensitization advantage of them
✓ Begins with the client reaching complete ✓ difficulty to express their thoughts, beliefs,
relaxation with eyes closed. and feelings
✓ A neutral scene is presented, and the client is ✓ who have social phobias
asked to imagine it. If the client remains relaxed,
he or she is asked to imagine the least anxiety Basic assumption is that people have the right to
arousing scene. express themselves.
✓ The therapist moves progressively up the
hierarchy until the client signals that he is Goals:
experiencing anxiety, at which time the scene is ✓ To increase behavioral repertoire so that
terminated. they can make the choice of whether to
✓ Relaxation is then induce and the scene is behave assertively in certain situations.
reintroduced again until little anxiety is ✓ To teach people to express themselves in
experience to it. ways that reflect sensitivity to the feelings
✓ Treatment ends when the clients is able to and rights of others.
remain in a relaxed state while imagining the
most anxiety producing scene. Focus on client’s negative self-statements, self-
defeating beliefs, and faulty thinking.
• Core of Systematic Desensitization
Repeated exposure in the imagination to anxiety Assertion training – in Groups
evoking situation without experiencing any negative ✓ Modeling and instructions are presented to
consequences. the group and members rehearse
behavioral skills in role-playing situations.
✓ Members is given feedback that consists
• Homework and follow-up are essential components of
of reinforcing the correct aspects of the
successful desensitization.
behavior and instructions on how to
D. Exposure Therapy (In vivo and Flooding) improve the behavior.
• In Vivo Exposure
Client exposure to the actual anxiety – evoking events G. Self-management Programs and Self-Directed
than simply imagining these situations. Behavior
2. Change can be brought about by teaching people to
• Flooding use coping skills in problematic situations
Intense and prolonged exposure to the actual anxiety 3. Advantages:
producing stimuli. • Treatment can be extended to the public
• Cost are minimal
BEHAVIOR THERAPY | 4
 THEORIES OF COUNSELING
Behavior Therapy: B.F. Skinner / Albert Bandura / Arnold Lazarus

• Steps in Self – management:

1. Select goals Modality Behaviors Questions to Ask
Goals should be established one at a time. It
✓ What would you like to
should be SMART and expectations be realistic. change?
✓ How active are you?
2. Translate goals into target behavior Overt
✓ What would you like to start
Identify behaviors targeted for change. Anticipate behaviors,
doing?
obstacles and think of ways to negotiate them. including acts,
✓ What would you like to stop
Behavior habits, and
doing?
3. Self – monitoring reactions that
✓ What are some of your
Deliberately and systematically observe own are observable
main strengths?
behavior and keep a behavioral diary. and measurable
✓ What specific behaviors
keep you from getting what
4. Work out a plan for change you want?
Devise an action program to bring about actual
change. ✓ What would you like to
change?
5. Evaluate an action plan ✓ How active are you?
Evaluate the plan for change to determine whether ✓ What would you like to start
goals are being achieved. doing?
Emotions,
✓ What would you like to stop
Affect moods, and
H. Multimodal Therapy: Clinical Behavior Therapy doing?
strong feelings
4. Grounded in social – cognitive theory and applies ✓ What are some of your
deserves behavioral techniques to a wide range of main strengths?
problems. ✓ What specific behaviors
keep you from getting what
you want?
5. Underlying assumption: Because individuals are
troubled by a variety of specific problems, it is
appropriate that a multitude of treatment strategies be ✓ Do you suffer from
used in bringing about change. unpleasant sensations,
Basic senses of such as pains aches,
6. Breadth is often more important than Depth. More touch, taste, dizziness, and so forth?
Sensation
coping responses a client learns in therapy, the less smell, sight, and ✓ What do you particularly
chance there is for a relapse. hearing like or dislike in the way of
seeing, smelling, hearing,
touching, and tasting?
7. The BASIC ID
Begins with a comprehensive assessment of seven
modalities of human functioning: ✓ What are some
✓ Behavior bothersome recurring
✓ Affective Responses dreams and vivid
✓ Sensations memories?
✓ Images How we picture
✓ Do you have a vivid
✓ Cognition ourselves,
imagination?
✓ Interpersonal Relationships including
Imagery ✓ How do you view your
✓ Drugs, Biological functions, nutrition, exercise memories,
body?
dreams, and
✓ How do you see yourself
fantasies
• Therapist identify one specific issue from each aspect now?
of BASIC ID as a target to change and teach clients a ✓ How would you like to be
range of techniques they can use to combat it. able to see yourself in the
future?
• Once main profile has been established, examination
of the interactions among the different modalities with
take place.

BEHAVIOR THERAPY | 5
 THEORIES OF COUNSELING
Behavior Therapy: B.F. Skinner / Albert Bandura / Arnold Lazarus

9. Mindfulness
✓ What are some ways in Being aware of our experiencing in a receptive way and
which you meet your engaging in activity based on nonjudgmental
intellectual needs? awareness
Insights,
✓ How do your thoughts
philosophies,
affect your emotions? Clients trains themselves to intentionally focus on their
ideas, opinions,
✓ What are the values and present experience while at the same time achieving a
self talk, and
judgments
beliefs you most cherish? distance from it.
✓ What are some negative
Cognition that constitute
things you say to yourself? 10. Acceptance
one’s
✓ What are some of your Receiving one’s present experience without judgment
fundamental
central faulty beliefs? or preference, but with curiosity and kindness and
values,
✓ What are the main striving for full awareness of the present moment.
attitudes, and
‘shoulds,’ ‘oughts,’ and
beliefs
‘musts’ in your life 1. Dialectical Behavior Therapy (DBT)
✓ How do they get in the way • For Borderline personality disorders.
of effective living?
• Have roots in Zen Buddhist principles
✓ How much of a social being
are you? • Emphasizes the importance of psychotherapeutic
✓ To what degree do you relationship, validation of the client, the etiologic
desire intimacy with importance of the client having experienced an
others? “invalidating environment” as a child, and
✓ What do you expect from confrontation of resistance.
the significant people in
Interactions with
Interpersonal
your life? • Acceptance – and change-oriented strategies
relationships other people
✓ What do they expect from
you? • Teaches clients to recognize and accept the
✓ Are there any relationships existence of simultaneous, opposing forces.
with others that you would
hope to change? • Acknowledging the fundamental dialectic
If so, what kinds of relationship will enable clients to integrated the
changes do you want? opposing notions of acceptance and change and
the therapist can teach them how to regulate their
✓ Are you healthy and health emotions and behaviors
conscious?
Drugs, ✓ Do you have any concerns Sample:
Drugs/
nutritional about your health? Client not wanting to engage in a certain behavior,
habits, and ✓ Do you take any prescribed yet knowing they have to engage in the behavior if
biology
exercise drugs? they want to achieve a desired goal.
patterns ✓ What are your habits
pertaining to diet, exercise, • Skills are taught in 4 modules:
and physical fitness? a) Mindfulness
Fundamental Skill in DBT and is considered
the basis for other skills taught.
I. Mindfulness and Acceptance Based Cognitive b) Interpersonal Effectiveness
Behavior Therapy Learning to ask for what one needs and
learning to cope with interpersonal conflict.
8. Core themes of Third Generation Behavior Therapies:
c) Emotion Regulation
✓ Expanded view of psychological health;
Identifying emotions, identifying obstacles to
✓ Broad view of acceptable outcomes in therapy
changing emotions and increasing positive
✓ Acceptance;
emotions
✓ Mindfulness
d) Distress Tolerance
✓ Creating a life worth living
Calmly recognizing emotions associated with
negative situations without becoming
overwhelmed by these situations.
BEHAVIOR THERAPY | 6
 THEORIES OF COUNSELING
Behavior Therapy: B.F. Skinner / Albert Bandura / Arnold Lazarus

2. Mindfulness – Based Stress Reduction (MBSR) • Commitment to action is also essential – making
• Much of our distress and suffering results from mindful decisions about what is important in life
continually wanting things to be different from how and what the person is willing to do to live a valued
they are actually are. and meaningful life.

• Skills taught – sitting meditation, mindfulness CRITICISMS OF BEHAVIOR THERAPY

meditation for 45 mins. daily. 1. May change behaviors, but it does not change feelings.
2. Does not provide insight
• Teach participants to relate to external and internal 3. Treats symptoms than causes
sources of stress in constructive ways. 4. Involves control and social influence by the therapist.

3. Mindfulness – Based Cognitive Therapy (MBCT)

• Integration of techniques from MBSR and cognitive
behavioral interventions

• Change client’s awareness of and relation to their

negative thoughts.

• 7 Sessions of MBCT Program:

✓ 1st session - identify negative automatic
thinking of people experiencing depression and
introduce some basic mindfulness practices.
✓ 2nd session – clients learn about the reactions
they have to life experiences and learn more
about mindfulness practice
✓ 3rd session – teaching breathing techniques
and focused attention on their present
experiencing
✓ 4th session – learning to experience the
moment without becoming attached to
outcomes as a way to prevent relapse.
✓ 5th session – teaches participants how to
accept their experiencing without holding on
✓ 6th session – describe thoughts as “merely
thoughts”, clients learn that they do not have to
act on their thoughts. “I am not my thoughts”
and “thoughts are not facts”
✓ 7th session – clients learn how to take care of
themselves, to prepare for relapse, and to
generalize their mindfulness practice to daily
life.

4. Acceptance and Commitment Therapy (ACT)

• Fully accepting present experience and mindfully
letting go of obstacles.

• Little emphasis on changing thoughts, instead

emphasis is on acceptance of cognitions.

• Assisting clients to choose values they want to live

by

BEHAVIOR THERAPY | 7