Domination in Behaviour Therapy

One of the areas where psychotherapy strays very close to the arena of domination is in the subject of behaviour modification. This derives from behaviourist theories of operant conditioning, in which behaviour is modified by rewarding desired behaviours and punishing undesirable behaviours.

A mainstream book on Cognitive behaviour Therapy by Jaqueline Persons (1989) has some interesting quotations. First a basic introduction:

"Rewards and punishments have powerful effects on behavior, and can be used in many ways in therapy. The use of rewards and punishments to accomplish behavior change has its origins in operant learning theory. Thorndike's (1935) Law of Effect states that behaviors that are followed by satisfaction are likely to be repeated, whereas those followed by discomfort are not likely to be repeated." (p82).

She goes on to give some examples of punishments, applied to patients who break the therapist's rules by activities such as turning up late, or failing to pay:

Punishers are stimuli that decrease the probability of the behavior they follow. An easily understood example of a punisher is a spanking given to a child who runs into the street. Punishers are more effective if they are intense, occur immediately after the response, and if the contingency between the response and the punishment is 100 % (Schwartz, 1984).

A clinical example of a rather benign punishment procedure is a strate­gy useful with patients who come late to sessions, make inappropriate telephone calls outside sessions, fail to pay the bill promptly, or engage in other types of behaviors that interfere with therapy (and can make the therapist furious!) (Linehan, 1987). When one of these therapy-interfer­ing behaviors occurs, it becomes the first item on the agenda for the next therapy session. This strategy makes good therapeutic sense for two rea­sons. First, a problem-solving discussion of the problematic behavior can teach the patient the skills she needs to prevent it from happening in the future. Second, this discussion is probably perceived by the patient as a punishment (she would probably prefer to be discussing other problems than the fact that she came five minutes late to the session). If so, this discussion will reduce the frequency of the behavior in question

When using punishment to eliminate a behavior, it is important to remember that the behavior is presumably occurring because it is posi­tively reinforced. For example, exhibitionistic behavior is reinforced by sexual gratification. Punishment to remove the behavior will not be very effective unless the therapist also teaches the patient alternative behaviors that will lead to gratification. .(p84-85)

Persons then discusses aversion therapy, which is a stronger form of behavior modification in which aversive stimuli (punishments) are used to discourage unwanted behaviors and reinforce alternative desired behaviors. Alcoholism has been discouraged by pairing alcohol with a substance that causes nausea, a technique for reducing smoking is to make a group of smokers smoke several cigarettes in rapid succession in an airless room, and electric shocks have been used to treat sexual problems.

The Wikipedia article on Aversion Therapy also describes it's controversial use in attempting to convert homosexual individuals to heterosexuality, and more information on the techniques used can be found at http://www.glbtq.com/social-sciences/aversion_therapy.html

Persons fianlly offers some advice for therapists wishing to apply aversion therapy:

The use of aversive stimuli presents personal, legal, and ethical dilem­mas for therapists. Many, if not most, therapists find the use of aversive stimuli distasteful, and some applications of aversive stimulation may even be illegal in some states.

There are three primary psychological disadvantages of aversive stimu­lation. First, aversive stimulation can produce the negative side effect of fear, which is unpleasant and can become a problem in itself. Aversive stimulation can disrupt even unpunished responses, perhaps via a gener­alized sense of fear or discomfort. Finally, the use of punishment, espe­cially with children, can provide an unfortunate model: if you don't like what someone else is doing, then hurt them to make them stop.

Despite the unattractiveness and many disadvantages of the use of aversive stimulation, these strategies cannot be discarded, because they offer hope for certain patients who need it desperately. Punishment is the most rapid procedure for removing undesirable behaviors, and in the case of an autistic child who batters herself, or a professional person whose exhibitionism threatens his personal and professional life with ruin, time is of the essence. As Stewart Nixon (personal communication) points out, one important protection for the therapist using aversive stimuli is to set up the procedure is such a way that the patient - not the therapist - administers the aversive stimulation. (p86-87)

References

Linehan, M. M. (1987). Dialectical behavioral therapy: A cognitive behavioral approach to parasuicide. Journal of Personality Disorders, 1, 328-333.

Persons, J. B. (1989). Cognitive therapy in practice: A case formulation approach. New York: Norton.

Schwartz, B. (1984). Psychology of learning and behavior (2nd ed.). New York: Norton.

Thorndike, E. L. (1935). The psychology of wants, interests, and attitudes. New York: Appleton-Century-Crofts.