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Here is a list of top ten therapies for the treatment of mental illness:- 1. Humanistic Therapies 2. Existential Therapy 3. Gestalt Therapy 4. Rational Emotive Therapy 5. Reality Therapy 6. Interpersonal Therapy 7. Group Therapy 8. Behaviour Therapy 9. Aversion Therapy 10. Flood Therapy.
1. Humanistic Therapies:
As a reaction to psychoanalytic and behaviouristic viewpoints of therapy, H.E.T. has come up. It has quite a recent origin. Many psychopathologists and clinical psychologists felt that the earlier methods did not consider either the existential problems or the potentialities of current people.
According to Coleman (1981) “In a society dominated by computerised technology and mass bureaucracy, proponents of the humanistic existential therapies see psychopathology as stemming in many cases from problems of alienation, if personalization, loneliness and the lack of a meaningful and fulfilling existence which are not met either by delving into forgotten memories or by correcting specific responses.”
To be more precise, the difference between the humanistic and existential techniques and analytic therapies lies in their basic view of people. While the Freudians hold the negative insects and desires by which people are driven, are to be controlled to check mental illness, the humanists and existentialists usually believe that people are by nature good and free.
But their inherent goodness and psychological health have been inhibited from appearing by internal and external forces and consequently they have become mentally ill. Thus, Duke and Nowicki (1979) remark “For the humanist existentialist theorists, psychotherapy typically involves the construction of situations and relationships in which positive growth can occur unhampered.”
Thus, the humanistic and existential therapists have developed certain techniques which attempt to remove the inhibition of the innate drive towards goodness rather than on replacing inhibition of negative drives towards instinctual satisfaction.
These therapies according to Coleman are based on the assumption that we have the freedom to control our own behaviour, that we can reflect upon our problems, make choices and take positive action.
Client Centred Therapy:
Developed by Carl Rogers (1951, 1961, 1966), the famous American psychologist, client centred therapy otherwise known as ‘Nondirective Therapy’ is probably the most frequently used humanistic mode of treatment. It is based on the theory of self actualization. This tendency for self actualization to fulfil one’s inner potentialities and to achieve something gives pleasure.
Rogers holds that behaviour disorder occurs when the individual is inhibited or blocked in achieving his inner potentialities by evading experiences that threaten his self concept. Due to this self defence process, an incongruence between the patient’s conscious experience and his actual reactions occur. This results in lowered integration, impaired personal relationship and maladjustment.
The self image of an individual according to Rogers is lowered or assessed inadequately due to faulty life experiences and consequently he evaluates himself incorrectly. This sort of negative self image about oneself makes one unhappy and anxious and leads to abnormality.
The aim of Rogers Nondirective therapy is to help the patient to undo the faulty evaluations and to assess oneself positively thereby. The therapist has to create a very friendly and warm atmosphere conducive for the growth of positive self concept.
The therapist would help the patient to develop an insight into the conflicts between his ideal self, the one which he is capable of being, his present self which others feel he is and his acceptance of his actual self. According to Shanmugam (1981) “Rogerian therapy involves acceptance, recognition and clarification of the feelings of the individual.”
The aim of the therapist is to touch the emotional aspect of the patient i.e., he is encouraged to talk about the deepest emotional feelings. The emotional conflicts which block self actualization are to be removed. This is done by emphasizing certain specific statements and expressions of the patient. The therapist helps the patient to see his emotional conflicts which are all the while troubling him.
The therapist should therefore be warm and responsive and should have complete rapport with the patient. He should produce the receptive climate through the process of empathy, where the patient should not hesitate to express anything, however personal and emotional it might have been.
Thus Duke and Nowicki (1979) view that the therapist produces the receptive climate through the process of empathy, congruence and unconditional positive regard. By empathy Rogers means the ability of the therapist to understand the world as the client sees it.
Congruence describes the high level of therapists genuineness i.e. the therapist responds only to the moment to moment feelings of the client. By unconditional positive regard, Rogers means the therapist’s complete total, non-judgmental acceptance of the client and all of his/her thoughts and feelings.
The main purpose of Rogerian therapy is therefore to break this incongruence. When he feels free to explore his real feelings in an understanding and warm atmosphere, he learns to accept his real feelings. This finally results in a better self concept, he becomes more self accepting and an integrated well balanced person. His self actualizing tendency re- emerges which helps in healthy mental development.
This technique is called nondirective as it has only to help the patient to direct himself rather than to intervene. He has neither to ask questions nor to give answers. He only helps the patient to clarify his true feelings by restating in his own words what the client has been saying. He never attempts to give any analysis or interpretation of what the patient says.
It is also called client centred therapy as the client has to do the entire job for therapy. He has to talk about himself, his emotions, to gain insight into his emotional and personal conflicts. The therapist has no scope to offer advice, to suggest or to clarify.
He has quite a passive role. He only shows the torch to the dark chamber of the patient’s interior. Thus Coleman (1981) comments, “The therapist does not offer advice, resort to moral exhortation or suggest right ways of behaving. Instead he restricts himself to reflecting and clarifying the patient’s feelings and attitudes in such a way as to promote self understanding, positive action and personal growth.”
Limitations:
The limitations of psychoanalysis are also found in this technique. The belief of Rogers that the self actualization tendency is innate in everyone, has been doubted by many. The effects of changes in the therapeutic sessions have also not been examined by empirical studies. The effectiveness of this procedure in real life situations has not thus been tested.
2. Existential Therapy:
As it emphasises the importance of existence of the human situation as experienced by the individual it is called existential therapy. Though existential therapy owes its origin to Kierkegarrd, Heidegger and Sartre it became an individual therapy with the contributions of Bin Swanger (1962, 1963), Boss (1963) and May (1967). Actually, Rollo May is said to be the pioneer of existential therapy in U.S.A.
Existential therapy has a lot of similarity with Rogerian therapy in that both emphasise phenomenological approach in terms of reality as perceived by the individual patient. Secondly, both stress on personal growth as significant since they believe in the innate tendency for such growth. Thirdly, they also emphasise interpersonal relationship. But the difference between the two techniques lies in the basic philosophy.
According to the existential therapy the present is more important than the past in determining action and feelings. It therefore emphasises the existence of the human situation as experienced by the individual. It stresses the uniqueness of the individual and his way of being in this world.
According to May (1967), “behaviour disorders arise as a result of unlived possibilities and untimely deadness. It is the growth of potentiality of the person that helps him to have a free, happy and healthy mental life.
In existential therapy authenticity, encounter and experiencing are sought. “Authenticity refers to the ability to remain in touch with the present, past and future existence, but to live in the present and be open to it. An awareness of one’s encounters with oneself and the world is also crucial. Existentialists feel that healthy people feel all interactions with the inner and outer world; exactly as they are”.
Gendlin describes this component of existential therapy “as rarely being amenable to verbal description but as something to be bodily felt and expressed.”
As opposed to the behaviour therapy, existential therapy requires the therapist to share himself his feelings, his values and his existence and not to let the client respond to him anything other than he really is.
Coleman views that “in existential approach the emphasis is on the ‘here’ and ‘now’, on what the individual is choosing to do and therefore be at this moment. This sense of immediacy, of the urgency of experience is the touch-stone of existential therapy and sets the stage for clarifying and choosing alternative ways of beings”.
A person whose existence is threatened due to unhealthy interpersonal relationship becomes anxious. The existential therapy makes the patient conscious of his own potential for the growth and development of his personality and self concept as well.
According to Duke and Nowicki (1979) existential therapy is a very difficult technique to describe because of the vagueness of many of its concepts. Secondly, there may be a gap in the perception of the things by the therapist and the patient. The patient may not actually perceive things in the similar fashion as a therapist perceives at a given time.
Evaluation of Humanistic Existential Therapy:
Critics of humanistic existential therapy argue that these therapies lack a highly systematized model of human behaviour. There is no common or agreed upon therapeutic procedure for the purpose of treatment and the process of what is expected to happen between the patient and the therapist is also vague.
There is no common or agreed upon procedure which one can follow while treating the patient through humanistic existential therapy. But on the other hand, the advocates of this technique assert that “there is no systematized model of human behaviour as the individual cannot be reduced to any abstraction and any attempt at doing so results in diminishing his status. Similarly, with the uniqueness of each person, it would be impossible to suggest what techniques should be used with all or even most individuals.” Coleman (1981).
However, in-spite of certain common limitations, as is found in any therapy, many of the humanistic existential models have had a tremendous influence on contemporary views of psychotherapy.
3. Gestalt Therapy:
After reading this article you will learn about the Use of Gestalt Therapy in Treatment of Abnormal Behaviour.
Having quite a recent origin, Gestalt therapy is most widely used of the humanistic existential therapies. It was developed by Fritz Pearls. As the name implies, Gestalt therapy emphasises on the integration of thought, feeling and action, unity of mind and body.
Gestalt therapy thus applies the principles of ‘whole’ of Gestalt psychology, and unlike many forms of psychotherapy which put emphasis on the verbal interaction, Gestalt therapy emphasises the importance of nonverbal communication. Pearls also put tremendous emphasis upon one’s entire experience as a source of self understanding and growth.
Gestalt therapists hold that those who are not fully aware of their total experience (here and there), good and bad, love and hate, etc., etc., and those who do not respond to the total Gestalt of their life, but to a limited and more often distorted portion of it are unhappy, anxious and maladjusted type.
Awareness involves both intellectual awareness and psychophysical awareness. Both should be considered and none should be ignored in dealing with life experiences and social interaction.
According to Duke and Nowicki (1979) “The goal of the Gestalt therapist is to coordinate intelligent awareness with psychophysical awareness so that the entire experience of a person is congruent. Saying that you are happy yet, acting as if you are miserable is incongruent, an awareness of your body language can help you to experience yourself as you really are. The Gestalt therapist works towards awareness and acceptance by psychophysical experience.”
When the total awareness is reached and genuine self expressing and interpersonal communication is re-established, the patient progresses towards healthy personality development and is free from complexes and anxieties.
Gestalt theories assert that when certain emotional needs are not gratified and they are always pushed to the ground instead of being brought to the figure cause tension, anxiety and mental disturbances.
Thus Shanmugam (1981) views, “There are people who prevent emotional needs from becoming the figure and this contributes to their suffering. A healthy person according to Gestalt therapist is able to move flexibly from one figure to another, gratifying each particular need as it arises so that his behaviour can be goal directed and satisfying.”
In the Gestalt therapy as in the Gestalt theory, the focus is on the present need or present state of the individual. If the patient wants to laugh heartily, but immediately checks, the Gestalt therapist will try to bring to the figure by encouraging to laugh heartily.
The aim of the Gestalt therapist also is to create atmosphere conducive in such a way that the patient can express his emotional feelings physically which he previously used to avoid. This externalization of emotional feelings will lead to an awareness in the person. This awareness will help him to confront the situation and change them for the better.
The therapist in other words, helps the patient to perceive first and then release his blocked feelings. The unresolved conflicts are most painful and dangerous for a balanced personality. It is the job of the Gestalt therapist to unfold these unresolved conflicts and traumas of life, by perceiving all these experiences of life in Toto .When these unresolved conflicts are externalized the psychological tensions are reduced.
Though it is commonly used in a group, attention is given individually. Besides other methods emphasis is put on the dreams of the patient to externalize his emotional conflicts and make him perceive the same in the present context.
The Gestalt therapists make attempts to focus on the more important elements of the person’s behaviour. Here training is given to the patient to be aware of one’s total self and one’s present environment. Currently, Gestalt therapy is mostly used.
It is a combination of strong and favourable aspects of psychoanalysis, (working through the intrapsychic conflicts), behaviourism (the focus on overt behaviour) and the humanistic existential orientation (the importance of self, awareness and present growth) as a result of which it has been a very widely and frequently used therapy.
4. Rational Emotive Therapy:
It is propounded by Albert Ellis (1958, 1973, 1975). It states that in our society from the very childhood we learn a lot of beliefs and values. These are continuously reinforced by various agents of socialisation as a result of which we continue to insist on these beliefs and irrational ideas, like ones performance should be accepted and approved by everyone in the society, that one should be loved by everyone, that one should be point to point perfect in each and every performance.
All these lead one to faulty emotional responses, the outcome of which is self defeating behaviour. Thus, according to this theory, irrational belief is the central cause of behavioural disorders. Some have tried to base the rational emotive theory on ABCDE Principles.
A represents antecedent factors, B for individual belief system, C for feelings or consequences or systems, D for confrontation of irrational ideas, E for outcome and removal of symptoms.
A factor represents that faulty emotional behaviour is caused by the person’s pattern of thinking. B factor represents that human behaviour and emotions can be altered by changing the pattern of thinking. C factor indicates that they cause themselves problem because they have learned one or more irrational ideas.
What are these irrational ideas? The concept that human unhappiness is God given, determined by fate and that people have little or no ability to control their sorrows and miseries, the idea that it is absolutely necessary for an adult human being to be loved and approved virtually by every person in his society, the idea that it is better to avoid than to face certain life difficulties and self responsibility and the firm belief that there is invariably a correct and perfect solution to all human problems and that if it is not achieved life becomes horrible and not worth living.
These are all due to faulty learning and faulty attitude leading to irrational thoughts, wishful thinking and intolerance of self. The therapist must make the client get rid of irrational beliefs so that he is free to have a logical existence.
Techniques of Rational Emotive Therapy:
The task of the therapist in this technique is to unveil and challenge the irrational and defeating ideas and false beliefs of the patient. He has to be explained and made understand how the function of these self defeating ideas are harmful for his personality development, how they are absolutely irrational and the root cause of his misery and unhappiness.
He has to be realised that he has to change his views and attitudes towards such things, that there is nothing like perfection, it is a relative term, that it is virtually impossible for a person to be loved by everyone and so on.
Realisation of these counselling will help him to alter his beliefs and undo his self defeating attitude. This will also lead to a complete change in the belief structure and faulty assumptions of the person in question.
The person will then feel free, relaxed and the symptoms of mental illness will disappear. Thus Coleman (1981) has remarked, “The rational therapy places heavy emphasis on cognitive change designed to help the individual deal effectively with his irrational should, ought’s and musts and to grow as a person and to live a creative, emotionally satisfying and fulfilling life.”
Evaluation:
The rational emotive therapy is effective in case of intelligent and young clients who have willingness and motivation to explore themselves, to change and modify their views and attitudes towards life if necessary.
It will also be more successful with a person having intellectual curiosity. Such a client will be willing and cooperative in accepting direction and guidance from the therapist. It can be successfully applied in case of neurotic and borderline psychotic cases.
However, this method of therapy will not be highly successful in those patients who are uncooperative, are not willing to do hard work and, maintain discipline and who are extremely narcistic in their nature. This therapy can also not be successful with clients having personality traits of dependency, obstinacy and dogmatism.
5. Reality Therapy:
Developed by Glasser (1965), Glasser and Junin (1973) the reality therapy is based on the assumption that the topmost need of a person are to love and to be loved. It also holds the contention that during early childhood, while going through the process of socialisation the child learns about the dos and don’ts of life, what are right and what is wrong and these help in the development of his later values.
But when the individual confronts the realities of life, there might be a conflict between his actual behaviour and his basic sense of right and wrong. When it contradicts his values, it subsequently leads to maladjustment and mental illness. The very feeling that he is incompetent and useless, the feeling that he is unable to do the right things of society and allied thoughts bring misery and anxiety in his life.
Reality therapy strives to help the client to believe and realise that he is not responsible for these things for which he considers himself responsible. The therapist attempts to clarify the basic values of the client and to impress upon him the fact to evaluate his behaviour in accordance to his values.
Sometimes also the patient’s values are influenced by the values of therapist who functions as a model or moral agent in reality therapy. To achieve this end, the patient is encouraged to talk about any topic, as long as it touches his conflicting values and he faces responsibility. But actual difficulty may arise whether in the practical field the client is actually learning to live in accordance with his values.
This difficulty can be avoided by teaching him to set realistic goals to achieve something. There should not be any conflict between his aspiration and achievement. He is helped 3o develop realistic goals and also he is taught to find realistic ways to reach these goals.
In this connection Glasser and Zunin (1973) write “Through accepting responsibility for one’s own behaviour and acting maturely to constructively change their behaviour, individuals find they are no longer lonely, symptoms begin to resolve and they are more likely to gain maturity, respect and love.”
Evaluation:
Application of reality therapy in an extensive manner has shown favourable results. As reported by Glasser and Zunin (1973) successful results in particular have been obtained in the treatment of delinquents and in helping widows of military personnel who were undergoing the deep emotional crisis of widowhood.
The author (1982) has also obtained successful results in the treatment of a few college students who because their socially tabooed and morally unacceptable acts were under severe guilt feeling, acute stress and the compulsion to commit suicide.
6. Interpersonal Therapy:
Under interpersonal therapy the following are included:
(1) Marital therapy,
(2) Family therapy and
(3) Transactional analysis.
i. Marital Therapy:
The growing need for marital therapy arose when plenty of unhappy, frustrated couples, with problems relating to their marriage life sought the help of clinical psychologists and psychiatrists. The gap in communication between unhappy couples, their lack of respect for each other and faulty role expectations lead to a lot of personality and adjustment problems.
The marital therapy thus mainly aims at clarifying and solving the marital problems as well as improving the interaction and inter-relationship between them. It aims at a happy reunion of the married couples helping them with better understanding, respect for each other and maturity. Faulty expectations on each other’s part, lack of understanding and adjustment may lead to marital discord.
According to Coleman (1981) while treating patients by the help of marital therapy, “Most therapists emphasise mutual need gratification, social role expectations, communication patterns and similar interpersonal factors.”
Lack of communication and family role expectations, lack of respect and understanding and insensitiveness for each others feelings shared on the way of marital happiness may also lead to marital unhappiness and maladjustment.
One of the primary problems of marital therapy is the emotion involvement of the couples which makes it quite difficult rather impossible for them to accept the realities of their relationship as suggested by the therapist. Thus, they are unable to see their own faults, though they can very well see the faults of the other partner.
They are not even prepared to listen to the therapist in this connection. To solve this problem and to make realise each other their own faults tape recordings of their conversation and conflicting arguments, quarrels, are played back to them afterwards to let them know and realise their faults.
Besides, training marital partners to use Rogerian nondirective therapy in helping each other, behaviour therapy to bring desired changes in the dealings of the partners by giving reinforcement for desired behaviour etc., may be followed to resolve marital discord. Eisler, (1974) used video tape, play backs and assertive training in case of three passive avoidant husbands to bring improvement in their married life.
ii. Family Therapy:
Though family therapy and marital therapy are more or less related and overlap with each other, they have different basis. Disturbed family environment leads to a lot of personality maladjustment as several studies and observations indicate. In many cases it was observed that after the patients have been cured and returned back home, again the disease relapsed.
The obvious cause of such relapse lied in the disturbed family environment. To check this and maintain the gain, modifications in the family environment is essential. According to Haley (1962) changes in the individual can occur only when there is change in the family system.
Many findings do indicate that the pathological behaviour of an individual is only a reflection of his family conditions. Ackerman (1963), Bowen (1971), Bell (1975) and others developed the view that individual symptoms reflect problems in the family. Emotionally unhealthy family system produces faulty emotional development in individual members. The trend of the family system is mirrored in the child’s personality.
The pathological personality of an unbalanced child may be cured to a great extent by treatment. But unless the family environment is changed from the circumstances which made him unbalanced, there is every possibility of the disease to relapse.
Therefore it is necessary to change the personality of the family members itself when the client returns home. In-fact, the whole family should be directly involved in therapy and not the pathologic individual alone. The aim of family therapy is therefore to restructure the family life so that the family members can function normally.
Conjoint Family Therapy:
Developed by Satir (1967) it is perhaps currently the most widely used therapy. She has held that faulty communications is a dangerous thing. It creates misunderstanding. Satir has suggested improvement and thorough change in the family system, faulty parent child relationship and communication procedures and interaction among the family members.
She has further added that keeping in view the needs of the family members, modifications and changes in the family system should be made.
Huff (1969) has stated that the therapist has to reduce the aversive value of the family for the identified patient as well as that of the patient for other family members. He further adds “The therapist does this by actively manipulating the relationship between members so that the relationship changes to a more positive reinforcing and reciprocal one.”
According to Hurwitz (1974) the family therapist acts as an intermediary whose functions include “interpreter, clarifier, emissary, negotiator and referee.” Currently video tape recordings have also been used in family therapy to make the family members conscious of the interactive pattern. Workshops are also introduced in family therapy.
iii. Transactional Analysis:
This modern technique of interpersonal therapy was developed by Ere Berne (1964, 1972). Here the task of the therapist is to analyse the interactions among the group members. So analysis is made in the group setting.
He also helps the participants to understand the ego states in which they are communicating with each other. Analysis of these communication patterns makes them conscious of their basic coping patterns and its effect upon their interpersonal relationship and life adjustment.
Transactional analysis thus holds up the mirror in front of the patient to show his own mind, own behaviour and to make him aware of the fact how we harm other people as well as ourselves through our behaviour. This very awareness may improve the inter-personal behaviour and may lead to more meaningful, useful, satisfying interpersonal relationships and life styles.
In the current age when we are going to cross the 20th century and reach the 21st century, the role of interpersonal relationship has become of tremendous importance. Man to-day faces multifarious problems in personal and interpersonal relationship which are quite damaging for his personality development.
From this point of view, the importance of interpersonal therapy has terribly increased. However, much research is to be conducted in this area to establish its importance empirically.
7. Group Therapy:
The need for group therapy arose during the second world war when there was shortage of psychiatrists. Psychologists further believed that human behaviour both normal and abnormal are largely influenced by group pressure. Thus, mental illness was treated in group settings.
The effectiveness of group therapy rapidly increased its application. It is a fact that most of the major psychotherapeutic techniques have used group find individual settings as well.
Group therapy can be of two types:
(a) Traditional group therapy and
(b) Encounter group therapy.
Traditional Group Therapy:
It consists of a small group of patients. Depending upon the age, need and necessities of the patients different procedures of treatment are followed. One of the advantages of group therapy is that a large number of cases can be treated simultaneously by one therapist.
Traditional group therapy is of two types:
1. Didactic group therapy. In this technique formal lectures and visual materials are presented by the therapist to the patients.
2. Psychodrama. It is based on the role playing technique of Moreno (1959).
Psychodrama helps the participants to express their emotional feelings through the respective characters they play. The patient may be given a particular role which may have some special significance for him or he may select the role as he wishes. The therapist participates and directs the proceeding of the drama.
It frees the patient from anxieties, worries, hostilities and traumatic experiences. Thus, through this role he helps the patient to express his blocked, suppressed and repressed feelings showing him insight into his own problems. The aim therefore is to help the patient to achieve emotional cathersis.
Besides Moreno, Sundberg and Tyler (1962) and Yablonsky (1975) have found the beneficial effect of Psychodrama. However, further research on this technique is essential in order to prove its effectiveness more strongly.
Encounter Group Therapy:
Currently encounter group therapy has become so popular that the total field of group therapy has been changed to encounter group therapy.
Two kinds of encounter groups are found:
(1) Evolving from sensitivity training or T. groups and
(2) Evolving from Esalen Institute of California, Synanon and other similar institutes in U.S.A.
In both these group therapies the participants are encouraged to talk in free and uninhibited manner. The therapists help them to observe how they react to people and how it affects their behaviour.
The participants of both these groups freely and frankly interact with each other through informal discussions which are normally confined to their present. The immediate and open feed-back from the group members including the therapist helps in reaching the desired goal.
Also in certain encounter groups physical exercises are introduced to create fatigue and break resistances in the interaction with the patient and the therapist. Other exercises are also introduced to bring a feeling of trust, intimacy and cooperation. Besides there are also other types of group therapies like peer self help groups.
Evaluation:
The effectiveness of group therapy has been emphasised by Rogers and other clinical psychologists. Many participants of the group therapy have also experienced the positive effect of profound group influence on their lives. Participation and mutual interaction in the group gives a feeling of cooperativeness, trust and belongingness.
But at the other end, it is argued, since openness and frankness is not accepted and encouraged in the society, sensitivity training does not have any partial utility. Rather, it is argued, it puts the individual to difficulties.
Secondly, the personal and emotional problems which are unmasked in the group if are not properly resolved, lead to serious complications. Thirdly, development of extra martial relationship and sexual involvements among the group members may lead to several marital and familial problems.
8. Behaviour Therapy:
Otherwise known as behaviour modification, behaviour therapy stems from the Watsonian principle of behaviourism. It is based on the principle of learning. Watson’s experiment on Albert to un-condition his fear towards white rabbit serves a fine example of the application of behaviour therapy to modify certain unwanted behaviours and habit patterns.
Behaviour therapy came into prominence during the 60s with the purpose for the treatment of abnormal and maladaptive behaviours. It developed mainly from the laboratory studies on learning in animals and humans.
According to Duke and Nowicki (1979) “Behaviour modification is a mode of individual treatment of psychological disturbances in which basic rules of learning discovered and tested in the laboratory are applied to the solution of human problems.”
Behaviour therapy deals with the systematic application of learning principles to change varieties of maladaptive behaviour. It is heartening to note thousands of systematic studies have been conducted and published on modification of maladaptive behaviour through learning principles.
This justifies the importance and popularity of behaviour therapy in psychotherapy. Behaviour therapy has also been effective at individual and group levels. Many proponents of this technique hold that it is experimentally tested, it is more scientific and reliable than psychoanalysis and humanistic therapies.
Since behaviour therapy has its roots in the work of Pavlov and Thorndike, currently the various methods of behaviour modification are either based on Pavlov’s or Thorndike’s work or a combination of both.
Behaviour therapists argue that all symptoms either psychotic or neurotic are learnt maladaptive behaviour acquired through classical conditioning and maintained through instrumental conditioning. Lack of opportunity to learn or defective conditioning procedures lead to the failure to acquire necessary response.
Similarly, certain conditioned reactions which have been learned under certain situations and have generalized to other situations also may lead to defective behaviour patterns.
Maladaptive behaviour therefore takes place because of deficient condition reactions or surplus conditioned reactions. The behaviour therapist in turn attempts to provide corrective conditioning experiences in which adequate response will be learned and adoptive response will be substituted for maladaptive ones.
The procedures adopted under behaviour therapy are direct conditioning, counter conditioning, extinction and other procedures such as reciprocal inhibition procedures in the treatment of pathological behaviour. Eysenck and his associates have been particularly interested in developing these techniques.
The application of simple classical conditioning has been used for the treatment of enuresis or bed wetting. An electrical device may be used which rings the bell when the child begins to urinate in his sleep.
With successive experiences, the sensations from bladder dissention which immediately precede the sound of the bell are sufficient to awaken the child. Thus, the child is conditioned to awake at the stimulus of bladder distention and his enuresis is checked.
Rachman (1963) has tentatively identified the major releasing and unlearning techniques that have been used by therapists:
1. Systematic desensitization based upon relaxation.
2. Operant conditioning of the adaptive responses.
3. Aversive conditioning.
4. Training in assertive behaviour.
5. Use of sexual responses.
6. Use of feeding responses.
Besides, flooding therapy, modelling and thought stopping are also included. Here we will discuss some of the important ones. One of the earliest illustrations of behaviour therapy was practiced by Zones (1924) who treated a 3 year old boy who was afraid of white rats, rabbits, fur coats, and cottons etc.
Jones presented competing responses in the presence of the rabbit and gradually brought the child closer to the rabbit as his toleration improved over a period of time and finally the child was able to play with the rabbit.
Also by providing a positive reinforcement in the presence of the rabbit, the child can be drawn nearer to the rabbit. This method of Jones was afterwards reinforced by Wolpe (1961, 1963 and 1969) by means of a number of experimental studies.
Evaluation of Behaviour Therapy:
From the standpoint of objectivity, behaviour therapy seems to have three advantages over humanistic and psychoanalytical therapies. The methods used in behaviour therapy are derived systematically from principles scientifically analysed and established many times in the laboratory, it is not only based on observation or treatment of a few cases.
The behaviours to be modified are specified, the methods to be used are clearly outlined, and the results can be readily repeated, evaluated and verified. Finally, the methods of treatment and the measurements of improvement can readily be communicable to another person. The results of the treatment may be verified elsewhere.
The results can be quantified and conclusions can be drawn on the effectiveness of the technique. As such, the behaviour therapies have some similarity with the rational therapies used in medical treatment of organic disease.
So far as the limitations of behaviour therapy are concerned, the following may be noted:
1. It does not take into account childhood experiences like other methods of psychotherapy.
2. In comparison to other types of psychotherapy behaviour therapy has proved relatively ineffective in the treatment of severe depression, childhood autism and schizophrenia. Moreover, different kinds of behaviour therapy vary in their effectiveness for particular problems or for a specific maladaptive behaviour.
In-spite of its limitations, behaviour therapy has been very effective in the treatment of varied types of maladaptive behaviour. Reports are there that the rate of cure is over 50 per cent and sometimes 90 per cent, depending upon the maladaptive pattern being treated.
Thus, it seems to be a very promising and rational approach to the treatment of neurotic behaviour, and maximum research work has been conducted in this area, which just suggests its importance. So much so that Eysenck has stated “Get rid of the symptom and you have eliminated the neuroses.”
However, most contemporary psychotherapists do not agree that the treatment of mental disorder is such a simple process as Eysenck has viewed.
Systematic Desensitization:
Systematic desensitisation is based upon the principle of reciprocal inhibition. It holds that since neurotic behaviour is acquired in anxiety provoking situations, successful treatment of neuroses requires the reinforcement of some response that is antagonistic to anxiety.
Wolpe has stressed the importance of muscular relaxation as a counter agent to anxiety. He has referred to these steps in the desensitisation process. These are relaxation, hierarchy of individuals anxieties and desensitisation. Each treatment session continues for 15 to 20 minutes and two or three times a week.
Relaxation:
It is the first step of therapeutic procedure and the patient is gradually taught relaxation during first six sessions. It includes the gradual relaxation of the muscles of the body which is considered as a counter agent to anxiety. In some cases, to include relaxation, drugs hypnosis and if necessary mediations are used.
Jacobson’s progressive relaxation technique involves relaxation of palm, fore head muscles, eyebrow muscles, inner eye muscles, tongue muscles, neck, lip, shoulder and jaw muscles, abdomen muscles and chest muscles.
By this technique the client learns how to tense or contract and relax various types of body muscles. Jacobson has opined that muscular relaxation causes marked reduction in autonomic and neuro muscular arousal and thereby reduces tension and anxiety.
Hull has mentioned that relaxation reduces anxiety that acts as a drive state facilitating conditioned avoidance response. From E.E.G. studies it is evident that relaxation generates alpha brain waves. It is generally applied in case of anxiety, psychogenic headache, psychogenic pain and hypochondria. It can effectively be applied as a secondary measure in other types of neurotic and psychosomatic disorders.
Hierarchy of individual’s anxieties:
The anxiety of the client is ranked in the descending order according to its intensity. But it is a difficult task specially in case of phobia, where the client may have a phobia for many objects and situations at the same time.
At this stage the patient is instructed to close his eyes and relax fully on a chair. Then the therapist describes different incidents and events beginning from neutral to severely emotional ones and he asks the patient to imagine, visualize and experience one of the stimulus situations.
He starts with least anxiety provoking scene and gradually reaches the scene which provokes maximum anxiety. When the patient reaches the stage of complete relaxation, and when the scenes which induced maximum anxiety before treatment, now do not induce any anxiety, the treatment is terminated. One patient may recover in 5-6 sessions while another may require 100 or more.
Usually during the first 5-6 sessions, patients are given intensive training in relaxation. Meanwhile, the therapist works out the hierarchy of patient’s anxiety by means of responses to a personality questionnaire, an analysis of the case history and investigating about situations which arouse anxiety even in the absence of objective threat.
Desensitization:
Desensitization sessions then may be conducted under hypnosis to induce complete relaxation. Drugs also may be used to aid in relaxation. Once relaxation has been achieved, the patient is instructed to imagine the weakest item on his anxiety hierarchy while completely relaxed.
Desensitization can also be conducted by exposing the patient to a real situation which brings in anxiety instead of making him to visualize the situation. This is known as the in vivo method. Systematic desensitisation has shown effective results in treating anxiety neuroses, phobias, examination neuroses and certain cases of impotency and frigidity.
Operant Conditioning Therapy:
It involves the manipulation of various reinforces to induce and strengthen desired responses. Food, usually considered as a powerful reinforce and motivator has been used in many therapeutic techniques to strengthen plenty of adaptive behaviour. In other words, its main aim is to modify the behaviour of the client using his own behaviour and by that influencing the learning process.
Desirable behaviour is reinforced by rewards and undesirable responses by punishment. In this technique rewards play a significant role and the reward is given only on the basis of the response. The rewards or reinforces may be verbal or non verbal.
Ayllon and Houghton (1962) even found that chronic schizophrenic patients have resumed eating themselves when food was used as a reinforce. It is really encouraging to note that the improvement in certain types of responses brought about by the manipulation of food also tended to generalise social interaction among patients.
Ayllon and Azrin (1968) applied the operant conditioning technique oak regressed patients admitted in a mental hospital. Their performances were systematically reinforced by rewarding them with plastic tokens. Gradually the entire life of each patient was more or less controlled by this method.
Operant conditioning is specially successful in case of children. Childhood problems like regression, enuresis, thumb sucking, temper tantrum, nail biting, asthma and poor school achievement have been effectively cured.
Ayllon and Kelly (1972) have reported effective results by using operant conditioning to train retarded children. Classical conditioning and operant conditioning methods have also been combined in several behaviour therapies. By changing the reward and punishment also both the techniques try to modify maladaptive behaviour.
9. Aversion Therapy:
The principle of aversion therapy involves the change of undesirable behaviour pattern through punishment i.e., associating a particular undesirable behaviour with a painful stimulus or punishment, the behaviour pattern is eliminated. It represents a clinical application of techniques like avoidance or escape learning, where electric shock or drugs are used to induce nausea and reduce undesirable behaviour.
Aversion conditioning has been successfully used for the treatment of chronic alcoholism and homosexuality. Barker and Miller (1973) have indicated the successful treatment of a man who was addicted to gambling for 12 years, through electric shock. He did not gamble for 18 months after the aversion therapy was applied on him.
A chronic alcoholic is given a glass of water with emetine and hypodermic injection of emetine hydrochloride. When subsequently alcohol is taken, these drugs produce nausea and the patient starts vomiting.
Now a days, in place of emetine, the drug tetralthyettiuram disulphide is used which produces quite a strong unpleasant reaction in the person who takes alcoholic drinks, like headache, increased pulse rate, difficulty in breathing etc. As a result of this type of unpleasant association with alcohol, the patient may give up drinking alcohol.
Lemere and Voegtilin (1950) indicated about a 40% chance of a long-term success with drug induced aversion therapy for alcoholics. Similarly, the child who does not give up breast feeding, inspite of repeated trials, when quinine is smeared on the mother’s breast, the child gives up sucking after a few trials because of the very unpleasant sensation it is associated with.
In the same manner homosexuality has been reported to be cured by the aversive therapy. Thus, by this principle, pathological behaviour responsible for causing anxiety is punished. In the similar manner, air phobia, sea phobia and other irrational fears can also be cured.
Critics of aversive therapy hold that cure by aversive conditioning is not permanent. Secondly, if aversive stimulus is not reinforced continuously, the patient may again repeat his behaviour disorder, it is argued. Thus, they say that outside the laboratory situation or experimental setting, the person once again may gamble or drink freely.
10. Flood Therapy:
In flooding technique, the client cognitively tolerates and adapts to anxiety provoking situation rather than avoiding it. In this technique the patient is to be exposed for a period to a very high intensive stimuli until his autonomic responsiveness is reduced to a state in which no anxiety could be aroused.
Portney has pointed out that the anxious or psychoneurotic possess the inner potentiality to face the real dangers without character distortion. In other words, flooding technique utilizes the individual’s inner potentiality to tolerate the stress rather than eliciting avoidance response. By the flooding technique deconditioning of maladaptive responses is established resulting in removal of symptoms.
After the extinction of maladaptive responses, learning of desirable responses, which are learned in the laboratory set up, are generalized or spread over the actual situation in the life.
Lechman (1969) pointed out that it involves in reduction of autonomic responses and secondly avoidance responses cease automatically when anxiety is reduced. The flooding technique, otherwise known as the impulsive therapy is similar to the systematic desensitization technique. It holds that neurotic behaviour is a result of conditioned avoidance of anxiety arousing stimuli.
In this technique the therapist intentionally and deliberately attempts to elicit a massive impulsion of anxiety either by asking the patient to imagine or by introducing to actual anxiety provoking stimuli the patient develops stress tolerance capacity and the stimulus loses its intensity to elicit anxiety and the patient gets relieved of the symptoms.
For example, if the child is terribly afraid of a cat, he may be made to handle the cat when he is with a person whom he trusts, and gradually he is shown that the cat is not actually harmful.
Similarly, a person who is afraid of crossing a river by boat because of water phobia, may be actually made to travel in a boat and experience the anxiety, showing him that the consequences of what he was so anxious about, do not generally take place. It is viewed that continuous exposure to anxiety provoking situation is more effective than trying to imagine or visualize a scene associated with anxiety.
Modelling:
The social learning theory developed by Bandura (1963) has given rise to modelling as a method of treatment of behaviour disorder. Bandura, Blonchard and Rotter have tried to help people to overcome their phobia for snakes by showing films and real people who are not afraid of snakes.
After seeing these films and models the fears of the patients for snakes are gradually reduced. This therapy is very successful in training children who have fear for cats, dogs, rats, spider, dark places, open places etc. Lazarus (1971) was quite successful in applying this technique for the treatment of interpersonal problems of patients.
The patients may be continuously exposed to observe the therapists and other performance in certain interpersonal relationship through actual practices, films and video tapes. Observation of this may also improve the interpersonal relationship of the patient.
Bellack, Hersen and Turner (1976) also used this technique successfully for the treatment of schizophrenics and found definite improvement in the social reactions of the patient.
Assertion Training:
This method is applied to develop effective adjective behaviour as well as to desensitize the patient. Because of conditioned anxiety those who had problems in interpersonal relationship, for them this method is helpful.
Assertive training is used when desired behaviours are prevented by personal timidity and interpersonal hesitancy. Those people who are afraid to express and insist upon their legitimate rights can be taught to express themselves and assert with rights without fear. Usually neurotic and socially withdrawn individuals are not assertive because of fear.
A person who is nonassertive may remain silent if someone who is much behind him in the queue to buy a train ticket, pushes him and goes ahead. Sometimes it is due to lack of learning, sometimes it is because of the wrong impression that assertion is hostility. Non-assertive people are prone to develop fear; timidity. They are withdrawing type, neurotic and miserable persons.
In assertion training the degree of non-assertiveness of the fearful person is first estimated through questionnaire. The behaviour therapist presents the client with a number of tasks in which they are asked to defend their rights.
They are trained to develop assertiveness if they fail to do so. As a result they gain self confidence. They must be explained that assertiveness and hostility are not same and to be assertive does not necessarily mean that one has to be hostile.
Duke and Nowicki (1979) state “The goal of the assertion therapist is to move the passive person from the extreme left side of the dimension to somewhere in the middle. Many people could benefit from moving from the extreme right towards the middle but such people rarely are as miserable as the non assertive person and usually don’t seek help.”
Thought Stopping:
Thought stopping as a method of treatment may be applied when uncontrollable ideas and mental perceptions come often. It is thus a procedure to check or eliminate unwanted, distressing and repetitive thoughts. The thought stopping technique was started by J.G. Taylor (1955) and subsequently developed by Wolpe (1973).
In this technique the client is asked to close his eyes and think deliberately the offending thought or un-adoptive thought sequence when the hallucinatory experience occurs the patient signals to the therapist and immediately the therapist shouts ‘stop it’. After the offending thoughts are gone, the client is told that by saying ‘stop’ to himself (when the offending thoughts arise in his mind) he too can stop his thoughts.
In thought stopping technique, when ‘stop’ is said repeatedly, it becomes aversive to the patient and as already pointed out, in aversive therapy any behaviour followed by an aversive stimulus usually occurs less frequently. Thought stopping in fact, acts as an available alternative response that reduces anxiety which serves on a drive set for avoidance conditioning.