In psychoanalysis, therapists help their patients look into their past to uncover repressed feelings. In behavior therapy, a therapist employs principles of learning to help clients change undesirable behaviors—rather than digging deeply into one’s unconscious. Therapists with this orientation believe that dysfunctional behaviors, like phobias and bedwetting, can be changed by teaching clients new, more constructive behaviors. Behavior therapy employs both classical and operant conditioning techniques to change behavior.
One type of behavior therapy utilizes classical conditioning techniques. Therapists using these techniques believe that dysfunctional behaviors are conditioned responses. Applying the conditioning principles developed by Ivan Pavlov, these therapists seek to recondition their clients and thus change their behavior. Emmie is eight years old, and frequently wets her bed at night. She’s been invited to several sleepovers, but she won’t go because of her problem. Using a type of conditioning therapy, Emmie begins to sleep on a liquid-sensitive bed pad that is hooked to an alarm. When moisture touches the pad, it sets off the alarm, waking up Emmie. When this process is repeated enough times, Emmie develops an association between urinary relaxation and waking up, and this stops the bedwetting. Emmie has now gone three weeks without wetting her bed and is looking forward to her first sleepover this weekend.
One commonly used classical conditioning therapeutic technique is counterconditioning: a client learns a new response to a stimulus that has previously elicited an undesirable behavior. Two counterconditioning techniques are aversive conditioning and exposure therapy. Aversive conditioning uses an unpleasant stimulus to stop an undesirable behavior. Therapists apply this technique to eliminate addictive behaviors, such as smoking, nail biting, and drinking. In aversion therapy, clients will typically engage in a specific behavior (such as nail biting) and at the same time are exposed to something unpleasant, such as a mild electric shock or a bad taste. After repeated associations between the unpleasant stimulus and the behavior, the client can learn to stop the unwanted behavior.
Aversion therapy has been used effectively for years in the treatment of alcoholism. One common way this occurs is through a chemically based substance known as Antabuse. When a person takes Antabuse and then consumes alcohol, uncomfortable side effects result including nausea, vomiting, increased heart rate, heart palpitations, severe headache, and shortness of breath. Antabuse is repeatedly paired with alcohol until the client associates alcohol with unpleasant feelings, which decreases the client’s desire to consume alcohol. Antabuse creates a conditioned aversion to alcohol because it replaces the original pleasure response with an unpleasant one.
In exposure therapy, a therapist seeks to treat clients’ fears or anxiety by presenting them with the object or situation that causes their problem, with the idea that they will eventually get used to it. This can be done via reality, imagination, or virtual reality. Exposure therapy was first reported in 1924 by Mary Cover Jones, who is considered the mother of behavior therapy. Jones worked with a boy named Peter who was afraid of rabbits. Her goal was to replace Peter’s fear of rabbits with a conditioned response of relaxation, which is a response that is incompatible with fear. How did she do it? Jones began by placing a caged rabbit on the other side of a room with Peter while he ate his afternoon snack. Over the course of several days, Jones moved the rabbit closer and closer to where Peter was seated with his snack. After two months of being exposed to the rabbit while relaxing with his snack, Peter was able to hold the rabbit and pet it while eating.
How can we assess the effectiveness of psychotherapy? Is one technique more effective than another? For anyone considering therapy, these are important questions. According to the American Psychological Association, three factors work together to produce successful treatment. The first is the use of evidence-based treatment that is deemed appropriate for your particular issue. The second important factor is the clinical expertise of the psychologist or therapist. The third factor is your own characteristics, values, preferences, and culture. Many people begin psychotherapy feeling like their problem will never be resolved; however, psychotherapy helps people see that they can do things to make their situation better. Psychotherapy can help reduce a person’s anxiety, depression, and maladaptive behaviors. Through psychotherapy, individuals can learn to engage in healthy behaviors designed to help them better express emotions, improve relationships, think more positively, and perform more effectively at work or school.
Many studies have explored the effectiveness of psychotherapy. For example, one large-scale study that examined 16 meta-analyses of CBT reported that it was equally effective or more effective than other therapies in treating PTSD, generalized anxiety disorder, depression, and social phobia. Another study found that CBT was as effective at treating depression (43% success rate) as prescription medication (50% success rate) compared to the placebo rate of 25%. Another meta-analysis found that psychodynamic therapy was also as effective at treating these types of psychological issues as CBT. However, no studies have found one psychotherapeutic approach more effective than another, nor have they shown any relationship between a client’s treatment outcome and the level of the clinician’s training or experience. Regardless of which type of psychotherapy an individual chooses, one critical factor that determines the success of treatment is the person’s relationship with the psychologist or therapist.
establishing the client-therapist relationship
Creating a therapeutic relationship, often referred to as the therapeutic alliance, is crucial for effective counseling. Here are key steps and strategies that counselors can use to establish and maintain a strong therapeutic relationship with their clients:
- Building Trust:
- Consistency and Reliability: Being punctual and consistent with appointments.
- Confidentiality: Ensuring the client that their privacy will be respected and maintaining confidentiality.
- Honesty: Being transparent and honest about the counseling process.
- Demonstrating Empathy:
- Active Listening: Paying full attention to the client without interrupting, and reflecting back what the client says.
- Understanding Emotions: Acknowledging and validating the client’s feelings and experiences.
- Showing Respect:
- Non-Judgmental Attitude: Accepting the client without judgment, regardless of their issues or background.
- Cultural Sensitivity: Being aware of and respecting the client’s cultural background, values, and beliefs.
- Effective Communication:
- Clarity: Explaining the counseling process, goals, and expectations clearly.
- Open-Ended Questions: Encouraging clients to express themselves more freely and deeply.
- Feedback: Providing constructive and supportive feedback.
- Establishing Rapport:
- Genuine Interest: Showing genuine interest in the client’s story and well-being.
- Warmth and Positive Regard: Being warm, approachable, and showing unconditional positive regard for the client.
- Creating a Safe Environment:
- Comfortable Setting: Ensuring the counseling environment is private, comfortable, and free of distractions.
- Safety: Making the client feel safe to express their thoughts and feelings without fear of criticism or retaliation.
- Collaborative Goal Setting:
- Shared Goals: Working with the client to set mutually agreed-upon goals for therapy.
- Client Involvement: Involving the client in the decision-making process regarding their treatment.
- Authenticity:
- Genuineness: Being authentic and transparent as a counselor, which helps in building a real and trusting relationship.
- Self-Disclosure: Sharing appropriate personal experiences when it can benefit the client’s growth and understanding.
- Adaptability:
- Flexibility: Being flexible and adapting the counseling approach to meet the unique needs and preferences of the client.
- Responsiveness: Responding to the client’s immediate needs and concerns in the moment.
- Monitoring and Repairing the Alliance:
- Regular Check-Ins: Frequently checking in with the client about how they feel the therapy is progressing.
- Addressing Ruptures: Being proactive in addressing and repairing any ruptures or misunderstandings in the therapeutic relationship.
There is not a one stop shop for treating and providing counseling to your client. In fact, each client will be so individual and specific, that you will often realize that you have to tailor your counseling methodology for each case. With each custom treatment plan, you will gain more skills and knowledge and learn more about yourself and treatment of addiction with diverse clients. What will remain the same and consistent with each case is ensuring you establish an effective therapeutic relationship with your clients.
Building a Therapeutic Alliance – Self Disclosure
Watch the video below that discusses the value of the therapist disclosing personal experiences that are relevant, to help build rapport and trust with their client.
references
Andrea Polites; Bruce Sewick; Jason Florin; and Julie Trytek (2024). Addictions Counseling Essentials. Press Publishing.
“The Efficacy of Psychodynamic Psychotherapy,” Jonathan K. Shedler, PhD, University of Colorado Denver School of Medicine; American Psychologist, Vol. 65. No.2.
