Assumptions of Behavioral
Therapy
The nice thing about Behavioral
interventions is that they force practitioners to bring some degree of science
and objectivity to skill training. In
any kind of activity that has anything to do with psychology-- no matter how
far removed -- there seems to be a
constant danger of falling onto various traps of "emotional
analysis". This kind of thinking
leads directly into the "I'm
Dysfunctional, You're Dysfunctional" syndrome that brought pride and
social status to victimhood during the 1980's. Roseanne Barr epitomized
the trend when she said "The fact that you cannot remember ritual
sexual abuse in your childhood is a warning sign that it probably happened to
you."
Behavioral interventions keep us
disciplined and focused on the objective aspects of the learning process. Without it we can't really be sure about the
effectiveness of our interventions, or even the behaviors the interventions are
supposed to affect. In short, the value
of incorporating behavioral philosophy into skills training is that it
insulates our interventions from subjective expectations that each of us
carries with us.
I've summarized the following seven
Assumptions of Behavioral Therapy in my own words. Immediately following my summaries is an excerpt from Behavioral
Therapy: Techniques and Empirical Findings, by David Rimm and John
Masters that expands, in great academic detail, on the seven assumptions. Dave and John aren't much of a threat to
Steven King's reputation, but give them a try anyway.
Behaviorism is practical; it
concerns itself with behaviors that are incompatible with local community
standards. Although there may be
causative factors that underlay the target behavior, (such as emotions like
anxiety or anger), behaviorism assumes they do not exist.
Behaviorism assumes that few
behaviors are not learned behavior, and strives to help clients
"unlearn" them, or learn new behaviors in their place.
Behaviorism is often used as a
training strategy for the severely mentally handicapped, such as the mentally
retarded, autistic or mentally ill.
Because the ability to learn is inherent in behaviorism these
populations are less likely to be lost to the "palliative care"
excuse for not supplying services.
("Don't waste your time. He
can't learn -- he's retarded.")
Behaviorism generates
interventions based on objective measurements of observed behaviors. Therefore clearly defined goals, strategies
and interventions are necessary order for interventions to maintain objectivity
and validity.
One of the dangers inherent in behaviorism
is the tendency for practitioners to unwittingly develop a small number of
"intervention templates" that are slightly modified to meet the needs
of different learners. Practitioners
must discipline themselves to remember that intervention plans are
individualized, and must adapt themselves to all aspects of the client.
Behaviorism is a pragmatic
approach that is concerned only with how a behavior manifests itself in the
present environment. Distant underlying
causes of behavior, or consequences that may manifest themselves far in the
future, are not relevant to behaviorism.
Behaviorism has a component of
strategies and interventions that have proven to be effective in laboratory
conditions and have been endorsed as being effective and ethically acceptable
by academia and behavior mod organizations.
Assumptions of Behavior
Therapy
From: Behavioral
Therapy: Techniques and Empirical Findings,
Rimm
and Masters
Behavior therapy approaches differ
considerably with respect to the emphasis placed on underlying processes in maladaptive
behavior (Yates, 1970). Operant conditioners have the strongest philosophical
commitment to remaining at a purely behavioral level. We have known operant
conditioners who are unfriendly to methods such as systematic desensitization
that, theoretically at least, are dependent on the existence and manipulation
of events below the level of overt behavior (visual imagery; anxiety).
Opposition to what some label as "mentalism" is not without
historical justification. (This issue is dealt with later in the chapter.)
The Wolpian methods emphasize
alleviating maladaptive anxiety. Whereas the Skinnerian (that is, operant
conditioner) might deal with the snake phobic simply by providing reinforcement
for successively greater approach behaviors to a snake (since the problem is
snake avoidance, for the Skinnerian), the Wolpian would conceptualize the
problem in terms of an underlying cause, anxiety, and attempt to alleviate this
internal state. It should be pointed out that while anxiety is by no means as "public"
as overt avoidance behavior, for Wolpe it is a state of arousal having definite
physiological referents, a state of arousal that can be detected (for instance,
by the galvanic skin response). In other words, anxiety is an internal
mediating response that is a good deal less obscure than underlying entities
(for example, oedipal conflict and organ inferiority) typically postulated by
schools of dynamic psychology.
Ellis's Rational‑Emotive
Therapy (Chapter X) is included in the present text because in our judgment it
shares many of the assumptions common to the more traditional behavioral
therapies. However, relatively speaking, Rational‑Emotive Therapy is a
depth approach. Thus, our snake phobic avoids snakes because he is anxious, but
the anxiety is generated by irrational thoughts (self‑verbalizations)
that, themselves, follow from a faulty system of beliefs. It should be pointed
out that in sharp contrast to the traditional depth approaches, the kinds of
cognitive activity so essential to Ellis's theoretical position can be
specified in a relatively concrete and unambiguous manner.
For the purposes of comparison,
consider how a psychoanalyst might conceptualize a snake phobia. He would agree
that the snake phobic does experience anxiety when confronted with a snake;
but, below this anxiety might be the unconscious perception of phallic‑like
properties of the snake. At a more basic level, there might be repressed
thoughts of castration, and at an even more fundamental level, a sexual love of
mother, also repressed. Note that whereas for Wolpe the underlying anxiety can
be detected by independent means, and for Ellis, cognitions conceived of as,
self‑verbalization can readily become overt verbalizations, subject to
public scrutiny; many of the underlying events postulated by psychoanalysis
are, according to the. theory, quite inaccessible.
Psychoanalytic and related dynamic
approaches were created and have been perpetuated largely by individuals
trained in the field of medicine (as the reader may know, psychiatrists are
physicians who specialize in psychiatry). It is not surprising then that
"models" of human maladaptive behavior associated with such
approaches have tended to borrow rather heavily from concepts associated with
physical illness. Hence, these dynamic conceptualizations have come to‑be
identified with such labels as the "medical model," or the
"disease model." In the medical model of psychological disorder,
maladaptive behavior is assumed to be symptomatic of an underlying pathological
state, or state of disease. it is also assumed that to cure the patient
suffering from "mental illness," it is necessary to eliminate the
inner state of pathology. That is, treating symptoms alone would be of no
benefit and, in the long run, might be harmful, since the inner disease might
be expected to intensify. It is interesting that the psychodynamic adaptation
of this model of illness is considerably more stringent. on the matter of
symptomatic treatment than the parent physical medicine model (witness the highly
successful symptomatic treatment of cystic fibrosis, or the somewhat less
successful, but very widespread, symptomatic treatment of the so‑called
common cold).
A corollary of assumption I is that
behavior therapy tends not to follow the medical model. Again, this is a matter
of degree. Were behavior therapy limited to operant conditioning, one could
fairly say, "behavior therapy rejects the medical model, and in
particular, the concept of the symptom." However, when one speaks of
anxiety‑mediated avoidance or self‑verbalizations that give rise to
maladaptive behavior, in a sense one is treating overt behavior as symptomatic
of something else. This 11 something else,'.' however, is not thought of as a
disease state, related to overt behavior in some mysterious or poorly specified
fashion. Instead, it refers to internal events triggered by external stimuli
that serve to mediate observable responding. Another important difference that
we have pointed out is that behavior therapy "internal" events are a
good deal more accessible to the client, as well as to the therapist, than
those of psychodynamic theory.
Symptom Substitution.
As many writers [see Eysenck
(1959); Yates (1958); Ullmann & Krasner (1965, 1969)] have noted,
psychodynamic approaches (especially psychoanalytic theory) predict that
removing a symptom while ignoring the underlying cause will result in either
the reoccurrence of that symptom or the appearance of a substitute symptom. It
is sometimes suggested that the hypothesis of symptom substitution follows from
the medical model (Ullmann & Krasner, 1965), but this requires some
qualification. If, by symptom substitution, we mean the appearance of new
symptoms as~ a result of removal of old ones, this doctrine is not consistent
with the medical model of physical illness, which does allow for symptomatic
treatment and does not ordinarily anticipate untoward consequences of this.
Thus, the physician in viewing fever as a symptom of an invasion of bacteria,
nevertheless, does not expect aspirin therapy or alcohol rubs to somehow cause
the appearance of a new ailment. Even certain psychiatric adaptations of the
medical model allow for treatment that can best be described as symptomatic.
Most psychiatrists who prescribe tranquilizers or electro‑shock therapy
would not argue that they are attempting to alleviate psychopathology at its
most basic level, nor would they prescribe such treatment expecting new and
terrible symptoms to appear.
In other words, the hypothesis of
symptom substitution (we could use the term, "doctrine," because this
is what it has become) does not follow from the medical model per se, but
rather, from one specific psychiatric derivative of the medical model, namely,
psychoanalytic theory. With respect to the psychoanalytic view of maladaptive
behavior, the analogy is often made to a kind of closed hydraulic system. If
something within the system gives rise to a build‑up of pressure, this
may cause a surface rupture, with fluid rushing out. However, since fluids are
not compressible, dealing with rupture (analogous to treating symptoms) only
increases the likelihood that a rupture will occur elsewhere. Given the
appropriateness of this analogy to human psychological functioning, symptom
substitution is a very plausible notion.
Naturally, the critical question
from our point of view pertains to whether or not symptom substitution is
likely to occur. As Bandura (1969) cogently pointed out, it is not really
possible to disprove this doctrine once and for all, because therapists who
apparently believe in symptom substitution have specified neither the nature of
the substitute symptom nor the circumstances under which it should occur. On
the other hand, it is possible for the behavior therapist to state his own
version of the hypothesis (Cahoon, 1968) and test it on the chance that
symptomatic treatment may indeed prove to be harmful. Generally, efforts in
this direction (and there have been many) have involved employing behavior
therapy to eliminate or weaken an undesirable behavior, waiting some reasonable
period of time, and then querying the individual as to whether or not he has
experienced some new symptom. Reviews of empirical findings (including case
histories and controlled experiments) indicate that the evidence is
overwhelmingly against symptom substitution (see Bandura, 1969; Lazarus, 1971;
Paul, 1969b,c; Wolpe, 1969; Wolpe & Lazarus, 1966).
As other writers (for example,
Bandura, 1969; Ullmann & Krasner, 1969) have noted, there are circumstances
in which one maladaptive response may substitute for another. Bandura (1969, p.
51) cites the example of antisocial behavior that has been suppressed by
punishment. If the individual is lacking in a socially acceptable response
which could serve the same end, he is likely to engage in some other antisocial
response. Wolpe (1969) notes that symptom substitution may occur when a
particular overt act is eliminated but the underlying autonomic (emotional)
response remains. For example, if so‑called compulsive hand‑washing
is suppressed, the individual might conceivably learn another maladaptive
anxiety‑reducing response. Thus, there is no axiom of behaviorism which
precludes the substitution of one maladaptive behavior for another. But from a
practical point of view, it is a phenomenon only rarely observed.
No currently popular theory of
human behavior or personality would take issue with the view that human beings
are, to a large extent, products of their environment. However, behavior
therapy specifies rather precisely how the environment may influence people, in
terms of established learning principles (for example, classical and operant
conditioning, modeling).
It must be stressed that while
maladaptive behavior differs from adaptive behavior in terms of its impact on
the individual and those around him, "healthy" and
"unhealthy" ways of responding are generally viewed as fundamentally
alike in other respects. Both ways of responding directly reflect the
individual's learning history and follow from the same general principles of
learning (Ullmann & Krasner, 1969).
Clearly, no modern behaviorist
would take the position that all maladaptive behavior is merely a consequence
of an unfortunate learning history. One would be hard pressed to argue that the
immediate behavioral deterioration following a traumatic central nervous system
accident arises from the sudden acquisition of a large number of new habits
(that is, learned responses). Similarly, few therapists would maintain that
mental retardation (for example, associated with microcephaly, mongolism,
cretinism, or hydrocephaly) arises exclusively, or even primarily, from unusual
learning experiences.
It seems reasonable to assume some
correspondence between the degree to which a particular response was learned
(as opposed to having been genetically determined) and the ease with which it
can be modified. On the other hand, as Davison (1968) has observed, the fact
that a response can be modified through learning does not prove it was acquired
through learning. For example, it is likely that certain components of human
sexual arousal are innate. Yet everyday experience suggests that we can learn
to be aroused (and later inhibit such arousal; see Chapter IX) in the presence
of stimuli that initially were "neutral" (articles of clothing or
pornographic literature).
The degree to which people in a
position of social control are aware of the importance of relatively
straightforward learning principles can be expected to have a major bearing on
the welfare of their charges. Consider the case of a child who very early in
life is diagnosed as severely mentally deficient (for instance, mongoloidism).
This child has two serious strikes against him. First, assuming the diagnosis correct,
there is something wrong with the way his brain functions, and it is unlikely
that he will ever behave in a totally normal manner, no matter what kind of
treatment he receives. Second, once he has been labeled severely mentally
deficient, the child may automatically be assumed by a great many el people
(including some professionals) totally incapable of learning. As a result,
rather than devoting the extra attention necessary to teach him things such as
elementary speech, the child is treated in a custodial manner and fails to
acquire many basic skills that he may be quite capable of acquiring. That
certain rudimentary skills may be taught to such individuals has become
abundantly clear in recent years (see Garcia, Baer, & Firestone, 197 1;
O'Brien, Azrin, & Bugle, 1972; O'Brien, Bugle, & Azrin, 1972).
Perhaps to a lesser extent, persons
labeled as autistic, schizophrenic, or even epileptic are frequently victimized
by significant others who severely underestimate the ability of these
individuals to learn. When this happens, a major learning deficit may be
expected, fulfilling the misguided prophecy.
Behavior therapy does not
conceptualize maladaptive responding as emanating from a "disturbed
personality" (a term that would have little meaning for most
behaviorists). Obviously, then, the goal of the therapist and client would not
be to facilitate the reorganizing or restructuring of the client's personality.
Instead, the aim would be to help alleviate the specific problems that are
interfering with the client's functioning, often by treating these problems in
a relatively discrete manner. For this reason, certain writers (see Breger
& McGaugh, 1965) have criticized behavior therapy for ignoring states such
as general unhappiness. The behavior therapist's preference is to determine the
specific events that lead to broad statements such as "I'm unhappy all the
time," or, "Life isn't worth living." The analogy may be made to
physical medicine, wherein the patient who feels "generally poor" is
asked to indicate specific ailments that are often treated separately. The
criticism that the physician is thereby ignoring his patient's "general
health" would not seem to be justified.
The Importance of Stimulus Control.
The term stimulus‑response (S‑R)
is often associated with behavioristic psychology. We prefer to avoid its
usage, because for many it has a highly simplistic connotation that does not do
modern behavior theory justice. On the other hand, a fundamental precept is
that behavior is under stimulus control and, when the behavior therapist
establishes his objectives, they are conceived of in terms of specific
responses occurring lawfully in the presence of specific stimuli. Thus, the
therapist using systematic desensitization is not trying to free his client
from "fearfulness," but rather from specific fears (for example, of
high places or certain animals). And the operant conditioner would not attempt
to increase the likelihood of all types of behavior in all circumstances, but,
rather, specific responses to specific stimuli. Even Rational‑Emotive
Therapy (see Chapter X), which is not usually thought of as exemplifying S‑R
psychology, does postulate lawful stimulus response relationships, with S and R
bridged by the thoughts the patient has.
Behavior Therapy and Trait
Psychology.
The position of most behavior
therapists is that behavior is highly situation‑specific. That is, by and
large what people learn are specific ways of reacting to, or dealing with,
specific situations. No one would argue that what we learn in one situation
does not carry over (that is, generalize or transfer) in some measure to other
situations. However, the behaviorist would argue that this occurs far, far less
than is suggested by traditional theorists (and by the layman, as well). The
opposite point of view is that people acquire traits that give rise to similar
responses in a wide variety of situations. For example, the individual who is
labeled as aggressive is expected to be unusually aggressive in most
situations; the liar is more likely to prevaricate than a nonliar, no matter
where he is; and the schizophrenic to emit more "crazy" behaviors
than the "normal" person in any situation. Mischel (1968) has carefully
examined the psychological research literature pertinent to traits. His general
conclusion may be stated as follows: A person's behavior in one set of
circumstances is generally a rather poor indicator of how he will respond in
situations that are markedly different. In other words, different behavioral
manifestations Of the same "trait" do not intercorrelate very highly.
The behaviorists' position is that a far better predictor of future behavior in
a given set of circumstances is past behavior in the same or similar
circumstances.
Many forms of traditional
psychotherapy provide essentially one method of treatment, regardless of the specific
nature of the client's presenting complaint. While it is true that the
psychodynamic therapist may occasionally opt to provide "support,"
rather than attempt to get at the deep‑seated roots of the problem, this
is usually seen as a stopgap procedure. If one assumes, as in the case of
psychoanalytic and related approaches, that present difficulties usually stem
from a lack of insight into critical childhood experiences, a single approach,
aimed at achieving such insight, seems to be plausible. Similarly, if an
individual's present problems are usually symptomatic of a need for
"unconditional positive regard" (Rogers, 1961), client‑centered
therapists are quite justified in providing this as the principal mode of
treatment.
In terms of the problems with which
he is confronted, the behavior therapist is willing to assume a more varied
etiology, although, obviously, learning is stressed. However, there is nothing
in present learning formulations that suggests that maladaptive responses are
acquired very early in life, or that they necessarily are mediated by the same
pervasive mental state (for example, a low self‑concept). As we shall see
later in the chapter, behavior therapy does not require that the precise
learning conditions giving rise to present difficulties be known. The point is
that the behavior therapy conceptualization of how psychological disorders
develop simply does not justify the use of what Bandura (1969, p. 89) has
called an "all‑purpose, single method" therapy. Instead, the
therapist will employ different procedures, depending upon the nature of the
problem. A person fearful of flying may be desensitized; a male who is timorous
in the presence of attractive females may receive assertive training; the
alcoholic may be offered aversive conditioning; the parent whose child
frequently throws tantrums may be instructed in operant principles; the obese
person may be taught principles of self-control; and so on.
If a practitioner tends to view all
psychological disorders as emanating from a common internal state or process,
and especially if the state is said to be "unconscious," he will be
most unlikely to interpret the client's "presenting" complaint as the
client's real problem. The client, who is ruled by powerful, but unconscious,
thoughts and impulses, is considered not competent to portray what ~is
troubling him in anything but a superficial and distorted manner. In fact, the
authors have known psycho dynamically oriented therapists who universally
assume that the client's true thoughts and feelings are, in fact, diametrically
opposed to what he expresses during initial therapy sessions.
Behavior therapists, on the other
hand, are considerably more likely to accept the client's presenting complaints
as valid (if he did not suffer from these complaints, he would not have sought
professional help). Naturally, one not need be an experienced professional
practitioner to know that in any initial encounter, people are not always
candid. The therapist, after all, is a stranger and, regardless of his formal
credentials, time is required to establish an atmosphere of trust and
confidence. Any experienced clinician will recall many cases involving clients
who after a few sessions, readily admitted to problems that were of far greater
concern to them than problems initially presented. It is also very common to
deal with clients presenting initial complaints who report other unrelated
problems during the course of therapy. Thus, the experienced behavior therapist
does not assume that he has "a complete picture" of his client after
I hour with him. At the same time, the client is generally viewed as an
essentially competent source of pertinent information, whose basic problems may
be specified without. the necessity of hundreds of hours of some form of
"uncovering" therapy.
The reader may wonder how a
behavior therapist might deal with the more bizarre complaints of the
hospitalized psychotic patient. In part, this would depend on the nature of the
overall treatment program. In Chapter ‑ VI, ward programs based upon
operant principles are described. Programs of this nature stress methodically
ignoring bizarre, inappropriate behavior, on the expectation that it will
extinguish, while, at the same time, reinforcing constructive, appropriate ways
of behaving. The assumption is that if certain of the patient's complaints (for
example, "I'm fearful because the Romans are going to crucify me.")
are not very credible, this is at least partly a result of the attention he has
received for such behavior. Individual treatment may readily be incorporated
into operant programs. When this is done, the therapist's approach to the
validity, of presenting complaints would be qualitatively the same as that for
outpatients in a consulting room office. Most individuals with a diagnosis of
"psychosis" exhibit relatively normal behavior much of the time
(especially if the ward program does not implicitly discourage this). The mere
fact that a patient occasionally exhibits bizarre forms of behavior in no way
implies that he possesses a "trait" of incompetence and that his
complaints are in general not to be taken seriously.
Individuals beginning therapy often
have the expectation that they will be asked to delve into their early childhood
experiences in minute detail. In fact, psychoanalytic and related approaches,
which have predominated in the United States throughout most of this century,
do strongly emphasize the importance of uncovering (that is, "working
through") early events assumed to be critical The assumption is that the
attainment of "insight" into these experiences (Fenichel, 1945) is of
curative value. Associated with this assumption are two critical questions.
First, how can we be sure that the content of such insights adequately describe
actual childhood events? As has been frequently pointed out (see Bandura,
1969), insights presented to the therapist represent a particular class of
verbal behaviors, subject to the same principles of learning that influence
other behaviors. Verbal conditioning (Greenspoon, 1955, 1962), wherein an
experimenter is able to increase certain types or classes of verbal response by
selective reinforcement, has been repeatedly demonstrated in the laboratory;
and given the presumably higher levels of motivation of most clients,
influences of this nature might be expected to be even more potent in the
therapeutic situation. A combination of selective reinforcement and verbal
modeling could easily account for findings (see Heine, 1953) wherein clients
tend to characterize their own behavior in terms of the orientation of their
particular therapist. The situation is analogous to a student adopting the
idiosyncratic language of a favorite professor or of an admired friend.
Considerations of this nature have led Bandura to suggest that what has been
labeled "insight" in the therapeutic interview might better be
characterized as "social conversion."
But, even assuming the
"validity" of insights obtained in psychotherapy, does it follow that
they will necessarily lead to reduction in maladaptive responding? Consider the
so‑called "war neurotics" (Grinker & Spiegel, 1945), who in
our experience are quite able to describe traumatic combat experiences that
relate to their presenting complaints in a manner far too plausible to
discount. Yet despite their apparent insights, their problems seem to remain.
For example, Rimm treated a World War 11 veteran who had served as bombardier
through some 50 combat missions and who, some 20 years later, was still fearful
of loud noises resembling the sounds of exploding flack or machine gun fire and
of high places (prior to the war he had experienced neither fear). Whereas such
insight appeared to be of little value, both fears were alleviated through
systematic desensitization. We are not suggesting that every phobic person is
able to recall precipitating traumatic events [Lazarus (197 1) has presented
data to the contrary 6]. But persons who can, would, nevertheless, seem to
remain phobic.
It should be obvious at this point
that behavior therapy rejects the notion that the attaining of what might be
labeled "historical insight" is curative. The necessity for detailed
explorations of the client's childhood is also rejected, although a certain
amount of biographical information is usually considered helpful. (This is
dealt with when intake interviews are discussed later in this chapter.)
As Kanfer and Phillips (1970) have
noted, behavior therapy is very "self‑conscious" when it comes
to scientific validation of its techniques. As we see in the section to follow,
empirical evidence may come in more than one form, with greater degrees of
scientific control providing greater degrees of certainty. The behavior
therapist does not assume that a technique is effective because it is derived
from a widely held theory, or because an authority has labeled it effective in
the absence of supporting evidence, or because common sense suggests its
effectiveness. Naturally, our thinking is affected by factors of this nature
that may serve as the source for hypotheses about human behavior. The essential
point, however, is that these hypotheses must then be‑ put to test.
It may seem quite obvious to the
reader that any accepted mode of treatment ought to be based upon established
scientific findings, rather than upon authority, convention, or suppositions bordering
on folklore. It should be stressed, however, that this has not been the
prevailing attitude throughout most of the history of psychotherapy. In the
writings of orthodox analysis (for example, Fenichel, 1945) it is common
practice to cite the edicts of Freud and other prominent analysts, much the way
medieval scholastics cited Aristotelian proclamations as incontrovertible proof
for their positions. Frequently, when
cases are cited in the psychodynamic literature, no mention whatsoever is made
of outcome, as if this were simply not an issue (see Astin, 1961).
Today clinical psychologists
usually hold doctoral degrees awarded through academic departments of
psychology. Most departments,
ostensibly at least, adhere to the so‑called "Boulder Model" of
training (see Cook, 1966), wherein the clinical psychologist is assumed to
possess critical scientific, as well as practical, skills. A fair portion of his training is devoted to
statistics, learning theory, research design, etc., with his instructors repeatedly
stressing the virtues of a "hard‑nosed," rigorous approach in
dealing with the subject matter of psychology.
On the other hand, not infrequently in the same department (and often on
internships), he finds himself exposed to other instructors or supervisors who
may pay lip service to scientific rigor, but who clearly take a prescientific
approach in dealing with clinical problems. Consider the student who questions
his professor as to the value of clinical interpretations on the grounds that
the interpretation is based upon a personality test that substantial research
has shown to be of questionable validity. The professor's response might be
that his own personal experience has provided him with a special
"feel" for the test in question, or that one should approach such
tests "intuitively." The student may receive the same sort of
response when he poses questions concerning particular therapy tactics. What he
is being told, implicitly, may be stated as follows: "While there may be a
place for scientific psychology in the laboratory, when you get down to actual
clinical cases, forget rigor. Instead, rely on the authority of experienced
clinicians and, later, on personal experience, intuition, 'gut' reactions,
etc."
Training of this nature is likely to
produce a professional "dual personality," wherein the clinician pays
due homage to the ethic of science, but, perhaps somewhat smugly, believes that
in terms of clinical practice, doing one's "own thing" is the
superior approach.
We are by no means advocating that
the practitioner ignore his personal experience, or that of others. During any
given therapy session, the clinician will be required to make many on‑the‑spot
decisions pertaining to issues which have not been researched in a manner that
would prove to be helpful. At such choice points, he can rely only on
experience. On the other hand, the clinician who is confronted with a problem
that has been well researched, but who pays such findings no heed, is clearly
doing his client a disservice.