BEHAVIORAL TECHNIQUES

Behavioral theories of counseling focus on a broad range of client behaviors. Often, a person has difficulties
because of a deficit or an excess of behavior. Counselors who take a behavioral approach seek to help clients
learn new, appropriate ways of acting, or help them modify or eliminate excessive actions. In such cases,
adaptive behaviors replace those that were maladaptive, and the counselor functions as a learning specialist for
the client (Krumboltz, 1966a). Also, “behavioral change opens doors to perceptual change” (Shadley, 2010, p.17).

 Behavioral counseling approaches are especially popular in institutional settings, such as mental hospitals
or sheltered workshops. They are the approaches of choice in working with clients who have specific
problems such as eating disorders, substance abuse, and psychosexual dysfunction. Behavioral approaches
are also useful in addressing difficulties associated with anxiety, stress, assertiveness, parenting, and social
interaction (Cormier, 2015; Seligman & Reichenberg, 2014).
 The principles of behavior modification can be adapted for use in counseling settings by explaining
behavioral ideas to the client and working with him to apply these ideas to bring about change in his own
life. This approach is often described as ‘behavioral self-control’ and involves functional analysis of
patterns of behavior, with the aim not so much of ‘knowing thyself’ as of ‘knowing thy controlling
variables’ (Thoresen and Mahoney 1974).
 Behavior therapy practitioners focus on directly observable behavior, current determinants of behavior,
learning experiences that promote change, tailoring treatment strategies to individual clients, and rigorous
assessment and evaluation.
 Behavior therapy has been used to treat a wide range of psychological disorders with different client
populations. Anxiety disorders, depression, posttraumatic stress disorder, substance abuse, eating and
weight disorders, sexual problems, pain management, and hypertension have all been successfully treated
using this approach (Wilson, 2011). Behavioral procedures are used in the fields of developmental
disabilities, mental illness, education and special education, community psychology, clinical psychology,
 rehabilitation, business, self-management, sports psychology, health-related behaviors, medicine, and
gerontology (Miltenberger, 2012; Wilson, 2011).

HISTORY- FOUNDERS/DEVELOPERS
B. F. (Burrhus Frederick) Skinner (1904–1990) is widely credited as the foremost figure responsible for
popularizing behavioral treatment methods. Applied behavior analysis, a cornerstone of behavioral therapy, is
considered a direct extension of Skinner’s radical behaviorism, rooted in operant conditioning (Antony, 2014).

Other notable figures in the behavioral therapy camp include historical pioneers such as Ivan Pavlov, known for
his work on classical conditioning, John B. Watson, a key proponent of behaviorism, and Mary Cover Jones,
recognized for her groundbreaking work in desensitization therapy.

In contemporary times, influential figures in behavioral therapy include Albert Bandura, renowned for his
contributions to social learning theory, John Krumboltz, known for his work on social learning theory of career
counseling, Neil Jacobson, a prominent researcher in behavior therapy for couples, Steven Hayes, the developer
of Acceptance and Commitment Therapy (ACT), and Marsha Linehan, the creator of Dialectical Behavior Therapy
(DBT). These contemporary figures have significantly advanced the field of behavioral therapy through their
research, theories, and therapeutic interventions.

FOUR AREAS OF DEVELOPMENT

Contemporary behavior therapy can be understood by considering four major areas of development: (1)
classical conditioning, (2) operant conditioning, (3) social-cognitive theory, and (4) cognitive behavior therapy.

CLASSICAL CONDITIONING
Classical conditioning, also known as respondent conditioning, involves the creation of a response through
pairing prior to learning. Ivan Pavlov's experiments with dogs exemplify classical conditioning, where placing
food in a dog's mouth leads to salivation, a respondent behavior. Through repeated pairing of food with a neutral
stimulus, like the sound of a bell, the dog eventually salivates to the bell alone. If the bell is sounded repeatedly
without food pairing, the salivation response diminishes and becomes extinct.

Joseph Wolpe's systematic desensitization, based on classical conditioning, illustrates the clinical application of
experimental learning principles. It helps individuals with intense fears, like fear of flying after a frightening
experience. Some may develop this fear without personal experience, possibly due to exposure to stimuli like
visual images of plane crashes, leading to differing views among researchers regarding its primary cause.

OPERANT CONDITIONING
Operant behaviors, such as reading, writing, driving a car, and eating with utensils, constitute significant
responses in daily life. Operant conditioning, a type of learning, centers on behaviors influenced by their
consequences. If these consequences, brought about by the behavior, are reinforcing or rewarding, the
likelihood of the behavior recurring increases. Conversely, if the consequences are aversive or provide no
reinforcement, the probability of the behavior recurring diminishes. Positive and negative reinforcement,
punishment, and extinction are examples of techniques illustrating operant conditioning's role in shaping
behavior. These techniques are applied in various settings, including parent education programs and weight
management programs, to foster prosocial and adaptive behaviors.

SOCIAL COGNITIVE THEORY

The behaviorists of classical and operant conditioning models focused solely on observable behaviors, excluding
mediational concepts like thinking processes, attitudes, and values. This omission may have been a reaction
against insight-oriented psychodynamic approaches. In contrast, the social learning approach, developed by
Albert Bandura and Richard Walters, is interactive, interdisciplinary, and multimodal. Social-cognitive theory
posits a triadic reciprocal interaction among the environment, personal factors (beliefs, preferences,
expectations, self-perceptions, and interpretations), and individual behavior. Here, environmental events on
behavior are largely determined by cognitive processes governing perception and interpretation. It assumes
individuals are capable of self-directed behavior change, with the person as the agent of change. Bandura
emphasizes self-efficacy, the belief in one's ability to master a situation and enact desired change. Social learning
is exemplified by how people acquire effective social skills through contact with others who model interpersonal
skills effectively.

COGNITIVE BEHAVIOR THERAPY

Cognitive Behavior Therapy (CBT) stands as the cornerstone of contemporary behavior therapy, enjoying
widespread popularity among psychologists. Its fundamental premise lies in the belief that individuals' beliefs
significantly influence their actions and emotions. This approach represents a notable evolution within the
behavior therapy movement, dating back to the early 1970s, when cognitive factors were integrated. By the mid-
1970s, this integration led to a shift from traditional behavior therapy to cognitive behavior therapy,
emphasizing the interplay among affective, behavioral, and cognitive dimensions. Today, CBT ranks among the
most favored therapeutic orientations, surpassed only by integrative therapies. Multimodal Therapy exemplifies
the integration of cognitive and behavioral dimensions within CBT. Moreover, recent decades have witnessed
the development of techniques emphasizing cognitive processes, particularly focusing on private events such as
clients' self-talk as mediators of behavior change. This integration of cognitive factors underscores CBT's efficacy
and versatility in addressing emotional and behavioral issues.

VIEW OF HUMAN NATURE.

Behaviorists, as a group, share the following ideas about human nature (Rimm & Cunningham, 1985; Seligman &
Reichenberg, 2014):

• A concentration on behavioral processes—that is, processes closely associated with overt behavior (except for
cognitive–behaviorists)

• A focus on the here and now as opposed to the then and there of behavior

• An assumption that all behavior is learned, whether it be adaptive or maladaptive

• A belief that learning can be effective in changing maladaptive behavior

• A focus on setting up well-defined therapy goals with their clients

• A rejection of the idea that the human personality is composed of traits

BASIC ASSUMPTIONS AND CHARACTERISTICS OF BEHAVIOUR THERAPY

1. Behavior therapy is based on the principles and procedures of the scientific method. Treatment goals are
defined objectively, and therapeutic techniques are systematically evaluated for effectiveness. Assessment of
problem behaviors and treatment outcomes is ongoing.

2. Behavior encompasses both overt actions and internal processes, such as cognitions and emotions, which are
operationally defined.

3. Behavior therapy focuses on current problems and influencing factors rather than historical determinants.
Understanding the past may provide useful information, but emphasis is on modifying present functioning
through functional assessment and changing environmental events.

4. Clients play an active role in behavior therapy by engaging in specific actions to address their problems.
Therapeutic tasks, including homework assignments, promote learning and the acquisition of new adaptive
behaviors.

5. Change can occur without insight into underlying dynamics or understanding the origins of a problem.
Behavioral changes may precede or coincide with increased self-understanding.

6. Assessment is an ongoing process that focuses on current determinants of behavior and informs the treatment
process. Cultural factors and social support networks are considered in assessment and evaluation.

7. Behavioral interventions are tailored to individual client problems, with various techniques utilized based on
effectiveness and suitability for the specific circumstances.
THERAPEUTIC GOALS
- The general goals of behavior therapy are to increase personal choice and create new conditions for learning.

- Specific treatment goals are defined by the client with the therapist's assistance.

- Formal assessment precedes treatment to determine target behaviors for change.

- Continuous assessment during therapy monitors progress toward goals.

- Goals should be clear, concrete, measurable, and agreed upon by both client and counselor.

- Therapeutic goals involve negotiation between client and counselor, resulting in a guiding contract for therapy.

- Goals may be altered throughout the therapeutic process as needed.

THERAPIST ROLE AND FUNCTION

Behavior therapists conduct a thorough functional assessment (or behavioral analysis) to identify the
maintaining conditions by systematically gathering information about situational antecedents (A), the
dimensions of the problem behavior (B), and the consequences (C) of the problem. This is known as the ABC
model, and the goal of a functional assessment of a client’s behavior is to understand the ABC sequence.

This model of behavior suggests that behavior (B) is influenced by some particular events that precede it, called
antecedents (A), and by certain events that follow it, called consequences (C).

 Antecedent events cue or elicit a certain behavior. For example, with a client who has trouble going to
sleep, listening to a relaxation tape may serve as a cue for sleep induction.
 Turning off the lights and removing the television from the bedroom may elicit sleep behaviors as well.
 Consequences are events that maintain a behavior in some way, either by increasing or decreasing it. For
example, a client may be more likely to return to counseling after the counselor offers verbal praise or
encouragement for having come in or for having completed some homework.
  A client may be less likely to return if the counselor is consistently late to sessions. In doing a behavioral
assessment interview, the therapist’s task is to identify the particular antecedent and consequent events
that influence, or are functionally related to, an individual’s behavior (Cormier, Nurius, & Osborn, 2013).

Behaviorally oriented practitioners tend to be active and directive and to function as consultants and problem
solvers. They rely heavily on empirical evidence about the efficacy of the techniques they apply to particular
problems.

Behavioral practitioners must possess intuitive skills and clinical judgment in selecting appropriate treatment
methods and in determining when to implement specific techniques (Wilson, 2011). They pay close attention to
the clues given by clients, and they are willing to follow their clinical hunches. They use some techniques
common to other approaches, such as summarizing, reflection, clarification, and open-ended questioning.
However, behavioral clinicians perform other functions as well (Miltenberger, 2012; Spiegler & Guevremont,
2010):

• The therapist strives to understand the function of client behaviors, including how certain behaviors
originated and how they are sustained. With this understanding, the therapist formulates initial treatment goals
and designs and implements a treatment plan to accomplish these goals.

• The behavioral clinician uses strategies that have research support for use with a particular kind of problem.
These evidence-based strategies promote generalization and maintenance of behavior change. A number of
these strategies are described later in this chapter.

• The clinician evaluates the success of the change plan by measuring progress toward the goals throughout the
duration of treatment. Outcome measures are given to the client at the beginning of treatment (called a baseline)
and collected again periodically during and after treatment to determine whether the strategy and treatment
plan are working. If not, adjustments are made in the strategies being used.
• A key task of the therapist is to conduct follow-up assessments to see whether the changes are durable over
time. Clients learn how to identify and cope with potential setbacks. The emphasis is on helping clients maintain
changes over time and acquire behavioral and cognitive coping skills to prevent relapses.

APPLICATION: THERAPEUTIC TECHNIQUES AND PROCEDURES

- Behavioral approaches emphasize specific therapeutic procedures that must be objectively effective.

- Continuous feedback from clients helps therapists evaluate the effectiveness of behavioral interventions.

- These approaches prioritize empirically supported and evidence-based practices.

- Research has demonstrated the effectiveness of behavior therapy across various populations and disorders.

- Lazarus advocates for the incorporation of diverse techniques into behavior therapy, regardless of their
theoretical origin.

- Behavior therapists are encouraged to tailor therapeutic procedures to individual clients rather than randomly
selecting techniques.

- Therapists often demonstrate creativity in selecting interventions.

- Specific behavioral techniques include applied behavioral analysis, relaxation training, systematic
desensitization, exposure therapies, social skills training, self-management programs, multimodal therapy, and
mindfulness and acceptance-based approaches.

ABA
Behavior therapists employ a diverse range of techniques rooted in operant conditioning principles to modify
behavior effectively. These techniques encompass various strategies such as reinforcement, punishment,
extinction, and shaping to encourage desired behaviors and discourage undesirable ones. Each technique is
carefully selected based on the client's unique needs and circumstances.
 Application of Operant Conditioning: Applied behavior analysis extends beyond traditional therapeutic
settings and is applied across diverse contexts and populations to address a wide spectrum of behavioral
problems. From clinical settings to educational environments and workplace scenarios, behavior
therapists utilize operant conditioning techniques to bring about meaningful behavior change.
 Functional Approach: Applied behavior analysis offers a functional approach to understanding and
addressing clients' issues. By focusing on altering antecedents (events that precede behavior) and
consequences (events that follow behavior), behavior therapists aim to identify the underlying factors
maintaining problematic behaviors. This functional analysis informs the design of targeted interventions
tailored to address specific behavioral patterns.
 Client-Specific Interventions: Therapeutic procedures in behavior therapy are not arbitrarily chosen but
are instead carefully tailored to suit the individual needs of each client. Behavior therapists demonstrate
creativity and flexibility in designing interventions that align with the client's goals, preferences, and
unique circumstances. This personalized approach enhances the relevance and effectiveness of the
therapeutic interventions.
 Empirical Support: The effectiveness of behavior therapy techniques is grounded in empirical evidence
and scientific rigor. Behavior therapists prioritize evidence-based practices, ensuring that interventions
are supported by empirical research demonstrating their efficacy. This emphasis on empirical validation
enhances the credibility and reliability of behavior therapy as a therapeutic approach.
 Behavior Assessment: Thorough behavior assessments are integral to the practice of behavior therapy.
Behavior therapists systematically gather information about the client's behaviors, identifying target
behaviors and their underlying determinants. This comprehensive assessment process enables behavior
therapists to formulate precise treatment goals and design intervention strategies tailored to address
specific behavioral issues.
 Continual Feedback: Behavior therapists receive direct feedback from clients throughout the therapeutic
process. This ongoing feedback loop allows therapists to monitor the effectiveness of interventions in real-
time, making timely adjustments as needed. By staying responsive to client feedback, behavior therapists
 can ensure that therapeutic interventions remain relevant and aligned with the client's evolving needs and
preferences.
 Incorporation of Diverse Techniques: Behavior therapists are encouraged to integrate diverse therapeutic
techniques, regardless of their theoretical origins, into their practice. This integrative approach allows
therapists to draw from a rich repertoire of evidence-based strategies to address complex client issues
comprehensively. By embracing diversity in therapeutic techniques, behavior therapists can customize
interventions to suit the unique needs of each client effectively.
 Long-Term Maintenance: Behavior therapy emphasizes not only the initial change in behavior but also the
long-term maintenance of these changes. Therapeutic interventions are designed to equip clients with the
necessary skills and strategies to sustain behavior change over time. By fostering the acquisition of coping
skills and adaptive behaviors, behavior therapy promotes enduring improvements in functioning and well-
being.
 Client Participation: Clients play an active role in the behavior therapy process, contributing to goal setting,
monitoring their behaviors, and engaging in therapeutic tasks. This collaborative approach empowers
clients to take ownership of their treatment journey, fostering a sense of autonomy and self-efficacy. By
actively involving clients in the therapeutic process, behavior therapists promote greater engagement and
commitment to behavior change goals.
 Focus on Positive Change: At its core, behavior therapy aims to facilitate positive changes in behavior and
functioning. By increasing personal choice, promoting learning, and fostering adaptive behaviors, behavior
therapy empowers individuals to lead more fulfilling and meaningful lives. The ultimate goal is to equip
clients with the skills and resources they need to navigate life's challenges effectively and achieve their
desired outcomes.

PROGRESSIVE MUSCLE RELAXATION

It is aimed at achieving muscle and mental relaxation and is easily learned. After clients learn the basics of
relaxation procedures, it is essential that they practice these exercises daily to obtain maximum results.

Jacobson (1938) is credited with initially developing the progressive muscle relaxation procedure.

They have been refined and modified, and relaxation procedures are frequently used in combination with a
number of other behavioral techniques. These include systematic desensitization, assertion training, self-
management programs, audiotape recordings of guided relaxation procedures, computer simulation programs,
biofeedback-induced relaxation, hypnosis, meditation, and autogenic training (teaching control of bodily and
imaginal functions through autosuggestion).

THERAPUTIC PROCEDURE: Progressive muscle relaxation involves several components. Clients are given a set
of instructions that teaches them to relax. They assume a passive and relaxed position in a quiet environment
while alternately contracting and relaxing muscles. This progressive muscle relaxation is explicitly taught to the
client by the therapist. Deep and regular breathing also is associated with producing relaxation. At the same time
clients learn to mentally “let go,” perhaps by focusing on pleasant thoughts or images. Clients are instructed to
actually feel and experience the tension building up, to notice their muscles getting tighter and study this
tension, and to hold and fully experience the tension. It is useful for clients to experience the difference between
a tense and a relaxed state. The client is then taught how to relax all the muscles while visualizing the various
parts of the body, with emphasis on the facial muscles. The arm muscles are relaxed first, followed by the head,
the neck and shoulders, the back, abdomen, and thorax, and then the lower limbs. Relaxation becomes a well-
learned response, which can become a habitual pattern if practiced daily for about 25 minutes each day.

The most common use has been with problems related to stress and anxiety, which are often manifested in
psychosomatic symptoms. Relaxation training has benefits in areas such as preparing patients for surgery,
teaching clients how to cope with chronic pain, and reducing the frequency of migraine attacks (Ferguson &
Sgambati, 2008). Some other ailments for which progressive muscle relaxation is helpful include asthma,
headache, hypertension, insomnia, irritable bowel syndrome, and panic disorder (Cormier et al., 2013).
SYSTEMATIC DESENSITIZATION
Systematic desensitization, based on the principle of classical conditioning, is a fundamental behavioral
procedure developed by Joseph Wolpe, a pioneer of behavior therapy. Clients imagine successively more
anxiety-arousing situations while engaging in a competing behavior. Gradually, clients become less sensitive
(desensitized) to the anxiety-arousing situation. This procedure can be viewed as a form of exposure therapy, as
clients expose themselves to anxiety-inducing images to reduce anxiety.

Systematic desensitization is an empirically researched behavior therapy procedure known for its effectiveness
in reducing maladaptive anxiety and treating anxiety-related disorders, particularly specific phobias.

THERAPUTIC PROCEDURE: Before implementing desensitization, the therapist conducts an initial interview to
gather information about the client's anxiety and background. This process, which may span multiple sessions,
helps the therapist understand the client's specific fears and triggers. The client begins a self-monitoring process
to observe and record anxiety-inducing situations throughout the week, aiding in the therapeutic process.
Additionally, some therapists utilize questionnaires to gather further data about anxiety-inducing situations.

If the decision is made to proceed with the desensitization procedure, the therapist provides the client with a
rationale for the treatment and outlines the process involved. This typically involves three main steps: (1)
relaxation training to help the client achieve a state of deep relaxation, (2) development of a graduated anxiety
hierarchy, and (3) systematic desensitization proper, which entails presenting items from the hierarchy while
the client remains in a deeply relaxed state. This structured approach, as outlined by Head and Gross (2008),
aims to systematically reduce anxiety responses to feared stimuli.

The desensitization process commences with the client achieving complete relaxation with closed eyes. Initially,
a neutral scene is presented, and the client imagines it. If relaxation is maintained, the therapist gradually
introduces scenes from the hierarchy of anxiety-inducing situations, starting with the least distressing. As the
client progresses up the hierarchy, they signal any onset of anxiety, prompting termination of the scene.
Relaxation techniques are then reinstated, and the scene is reintroduced until minimal anxiety is experienced.
Treatment concludes when the client can remain relaxed while imagining the formerly most anxiety-provoking
scene. The essence of systematic desensitization lies in repeated exposure to anxiety-provoking situations in
imagination without adverse consequences.

Homework and follow-up play crucial roles in reinforcing desensitization gains. Clients are encouraged to
practice relaxation techniques daily and gradually expose themselves to real-life anxiety-inducing situations.
This approach has strong empirical support for treating anxiety and various other conditions, offering clients a
gradual and symbolic means of confronting their fears.

EXPOSURE THERAPY
Exposure therapies are designed to treat fears and other negative emotional responses by introducing clients,
under carefully controlled conditions, to the situations that contributed to such problems. Exposure is a key
process in treating a wide range of problems associated with fear and anxiety.

IN VIVO
In vivo exposure therapy involves clients facing real-life anxiety-inducing situations rather than imagining them.
It's a fundamental technique in behavior therapy, involving a structured approach starting with a functional
analysis to identify feared situations. Clients then gradually confront these situations, learning to manage
anxiety without avoidance. Therapists may accompany clients for safety in certain cases, ensuring ethical
boundaries.

FLOODING
Flooding exposes clients to anxiety-provoking stimuli either in real-life situations (in vivo flooding) or through
imagination (imaginal flooding) for prolonged periods. Despite experiencing anxiety, clients learn that feared
consequences do not occur, leading to anxiety reduction over time. In vivo flooding rapidly reduces anxiety by
preventing maladaptive responses. Imaginal flooding offers flexibility in treating traumatic events ethically and
practically. Both forms are widely used in treating anxiety-related disorders.

 Considerations and Ethical Aspects: Prolonged exposure may be uncomfortable for some clients,
necessitating therapist collaboration to build motivation and readiness. Clients need adequate information
about exposure therapy's temporary stress to make informed decisions. Despite its effectiveness, exposure
therapy may not suffice alone for severe and multifaceted disorders, often requiring multiple behavioral
interventions. Combining imaginal and in vivo exposure aligns with therapy trends to enhance
effectiveness through treatment packages.

EYE MOVEMENT DESENSITIZATION AND REPROCESSING

Eye Movement Desensitization and Reprocessing (EMDR) is a specialized form of exposure therapy used in the
treatment of traumatic memories. It involves three main phases: assessment and preparation, imaginal flooding,
and cognitive restructuring. Developed by Francine Shapiro, EMDR utilizes rapid, rhythmic eye movements and
bilateral stimulation to address traumatic stress in various populations, including children, combat veterans,
survivors of crime, and individuals with anxiety, depression, addiction, and phobias.

 Safety and Training: Ethical use of EMDR requires proper training and clinical supervision due to the
powerful reactions it may elicit in clients. Practitioners must prioritize the safety and welfare of their
clients and should only use EMDR after receiving authorized training and supervision. Shapiro emphasizes
the importance of clinical competence and adherence to ethical guidelines in using this approach.
 Controversy and Effectiveness: There is debate over the mechanism of action of EMDR, with some
questioning the role of lateral eye movements in creating change. However, research suggests that EMDR
yields similar or superior results compared to other trauma treatments. Controlled studies indicate its
effectiveness in treating trauma, and it has accumulated more research evidence than any other trauma
therapy method over its 20-year history.
  Future Directions: Prochaska and Norcross predict increasing adoption of EMDR training among
practitioners, further research to evaluate its effectiveness compared to other therapies, and exploration of
its applicability to disorders beyond PTSD. As research and practice in EMDR continue to evolve, its
effectiveness and potential applications are expected to be better understood.

MULTI-MODAL THERAPY: CLINICAL BEHAVIOR THERAPY

Multimodal therapy is a comprehensive, systematic, holistic approach to behavior therapy developed by Arnold
Lazarus. Lazarus claims that the term “multimodal behavior therapy” is somewhat of a misnomer. Although the
assessment process is multimodal, the treatment is cognitive-behavioral and draws upon empirically supported
methods.

In terms of clinical practice, behavior therapy and multimodal therapy are very similar.

Multimodal therapy is grounded in social-cognitive theory and applies diverse behavioral techniques to a wide
range of problems. This approach serves as a major link between some behavioral principles and the cognitive-
behavioral approach that has largely replaced traditional behavioral therapy. Multimodal therapy is an open
system that encourages technical eclecticism in that it applies diverse behavioral techniques to a wide range of
problems.

Multimodal therapists borrow techniques from many other therapy systems. Multimodal therapists take great
pains to determine precisely what relationship and what treatment strategies will work best with each client
and under which particular circumstances.

The underlying assumption of this approach is that because individuals are troubled by a variety of specific
problems it is appropriate that a multitude of treatment strategies be used in bringing about change.
Therapeutic flexibility and versatility, along with breadth over depth, are highly valued, and multimodal
therapists are constantly adjusting their procedures to achieve the client’s goals.
Multimodal therapists tend to be very active during therapist sessions, functioning as trainers, educators,
consultants, coaches, and role models. They provide information, instruction, and feedback as well as modeling
assertive behaviors. They offer suggestions, positive reinforcements, and are appropriately self-disclosing.

THe BasIc I.D.: The essence of Lazarus’s multimodal approach is the premise that the complex personality of
human beings can be divided into seven major areas of functioning: B (behavior), A (affective responses), S
(sensations), I (images), C (cognitions), I (interpersonal relationships), and D (drugs, biological functions,
nutrition, and exercise) (Lazarus, 1989, 1992a).

Multimodal therapy begins with a comprehensive assessment of the seven modalities of human functioning and
the interaction among them. A complete assessment and treatment program must account for each modality of
the BASIC I.D., which is the cognitive map linking each aspect of personality.
A major premise of multimodal therapy is that breadth is often more important than depth. The more coping
responses a client learns in therapy, the less chance there is for a relapse.

SELF MANAGEMENT
Self-management strategies include self-monitoring, self-reward, self-contracting, and stimulus control. The
basic idea of self-management assessments and interventions is that change can be brought about by teaching
people to use coping skills in problematic situations.

Generalization and maintenance of the outcomes are enhanced by encouraging clients to accept the
responsibility for carrying out these strategies in daily life.

An advantage of self-management techniques is that treatment can be extended to the public in ways that cannot
be done with traditional approaches to therapy. Another advantage is that costs are minimal. Because clients
have a direct role in their own treatment, techniques aimed at self-change tend to increase involvement and
commitment to their treatment.

In self-management programs, people make decisions concerning specific behaviors they want to control or
change. People frequently discover that a major reason they do not attain their goals is the lack of certain skills
or unrealistic expectations of change. Hope can be a therapeutic factor that leads to change, but unrealistic hope
can pave the way for a pattern of failures in a self-change program. A self-directed approach can provide the
guidelines for change and a plan that will lead to change.

Watson and Tharp (2007) gave basic steps:

1. Selecting goals. Goals should be established one at a time, and they should be measurable, attainable, positive,
and significant for you. It is essential that expectations be realistic.

2. Translating goals into target behaviors. Identify behaviors targeted for change. Once targets for change are
selected, anticipate obstacles and think of ways to negotiate them.

3. Self-monitoring. Deliberately and systematically observe your own behavior, and keep a behavioral diary,
recording the behavior along with comments about the relevant antecedent cues and consequences.

4. Working out a plan for change. Devise an action program to bring about actual change. Various plans for the
same goal can be designed, each of which can be effective. Some type of self-reinforcement system is necessary
in this plan because reinforcement is the cornerstone of modern behavior therapy. Self-reinforcement is a
temporary strategy used until the new behaviors have been implemented in everyday life. Take steps to ensure
that the gains made will be maintained.

5. Evaluating an action plan. Evaluate the plan for change to determine whether goals are being achieved, and
adjust and revise the plan as other ways to meet goals are learned. Evaluation is an ongoing process rather than
a one-time occurrence, and self-change is a lifelong practice.
Self-management strategies have been successfully applied to many populations and problems, a few of which
include coping with panic attacks, helping children to cope with fear of the dark, increasing creative
productivity, managing anxiety in social situations, encouraging speaking in front of a class, increasing exercise,
control of smoking, and dealing with depression (Watson & Tharp, 2007).

Research on self-management has been conducted in a wide variety of health problems, a few of which include
arthritis, asthma, cancer, cardiac disease, substance abuse, diabetes, headaches, vision loss, depression,
nutrition, and self-health care (Cormier et al., 2013).

MODELLING/ SOCIAL LEARNING

Social skills training focuses on enhancing an individual's ability to interact effectively in various social
situations, helping them develop interpersonal competence. It aims to improve communication in ways that are
appropriate and effective, particularly for individuals experiencing psychosocial problems related to
interpersonal difficulties.

 Techniques and Effectiveness: Social skills training employs various behavioral techniques such as
psychoeducation, modeling, behavior rehearsal, and feedback. These methods are effective in increasing
clients' interpersonal skills and addressing psychosocial issues. The training can be tailored to individual
needs and has a broad applicability across different contexts.
 Key Elements: Segrin outlines key elements of social skills training, including assessment, direct
instruction, modeling, role-playing, and homework assignments. Clients learn information applicable to
interpersonal situations, observe modeled skills, and actively practice desired behaviors through role-
playing. Feedback and reinforcement help refine clients' performances and facilitate the adoption of new
social skills.
 Applications: Social skills training has evidence-based applications in various areas such as
alcohol/substance abuse, ADHD, bullying, social anxiety, children's emotional and behavioral problems,
couples therapy, and depression. Specific variations include anger management training for individuals
 struggling with aggression and assertion training for those lacking assertive skills. These applications
highlight the versatility and effectiveness of social skills training across different populations and issues.

ASSERTIVE TRAINING
The major tenet of assertiveness training is that a person should be free to express thoughts and feelings
appropriately without feeling undue anxiety (Alberti & Emmons, 2008). The technique consists of
counterconditioning anxiety and reinforcing assertiveness. A client is taught that everyone has the right (not the
obligation) of self-expression.

Assertion training can be useful for those

(1) who have difficulty expressing anger or irritation,

(2) who have difficulty saying no,

(3) who are overly polite and allow others to take advantage of them,

(4) who find it difficult to express affection and other positive responses,

(5) who feel they do not have a right to express their thoughts, beliefs, and feelings, or

(6) who have social phobias.

The basic assumption underlying assertion training is that people have the right (but not the obligation) to
express themselves.

 One goal of assertion training is to increase people’s behavioral repertoire so that they can make the choice
of whether to behave assertively in certain situations. It is important that clients replace maladaptive
social skills with new skills.
  Another goal is teaching people to express themselves in ways that reflect sensitivity to the feelings and
rights of others. Assertion does not mean aggression; truly assertive people do not stand up for their rights
at all costs, ignoring the feelings of others.

The therapist both teaches and models desired behaviors the client wants to acquire. These behaviors are
practiced in the therapy office and then enacted in everyday life. Most assertion training programs focus on
clients’ negative self-statements, self-defeating beliefs, and faulty thinking. People often behave in unassertive
ways because they don’t think they have a right to state a viewpoint or ask for what they want or deserve. Thus
their thinking leads to passive behavior.

Effective assertion training programs do more than give people skills and techniques for dealing with difficult
situations. These programs challenge people’s beliefs that accompany their lack of assertiveness and teach them
to make constructive self-statements and to adopt a new set of beliefs that will result in assertive behavior.

Assertion training is often conducted in groups. When a group format is used, the modeling and instructions are
presented to the entire group, and members rehearse behavioral skills in role-playing situations. After the
rehearsal, the member is given feedback that consists of reinforcing the correct aspects of the behavior and
instructions on how to improve the behavior. Each member engages in further rehearsals of assertive behaviors
until the skills are performed adequately in a variety of simulated situations (Miltenberger, 2012).

Because assertion training is based on Western notions of the value of assertiveness, it may not be suited for
clients with a cultural background that places more emphasis on harmony than on being assertive. This
approach is not a panacea, but it can be an effective treatment for clients who have skill deficits in assertive
behavior or for individuals who experience difficulties in their interpersonal relationships. Although counselors
can adapt this form of social skills training procedures to suit their own style, it is important to include
behavioral rehearsal and continual assessment as basic aspects of the program.

STRENGTHS AND CONTRIBUTIONS

- Directly addresses symptoms: The approach deals directly with symptoms, making it effective for clients
seeking help for specific problems. Counselors can often assist clients immediately.

- Focuses on the present: Clients do not need to delve into the past to obtain help in the present. A behavioral
approach saves both time and money by focusing on current issues.

- Offers a variety of techniques: Behavioral counseling provides numerous techniques for counselors to use,
allowing for flexibility in treatment approaches.

- Grounded in learning theory: The approach is based on learning theory, providing a well-formulated
understanding of how new behaviors are acquired.

- Supported by professional organizations: The approach is supported by organizations like the Association for
Behavioral and Cognitive Therapies (ABCT), which promotes the practice of behavioral counseling methods.

LIMITATIONS
- Reductionist focus: The approach does not address the total person but only explicit behavior, leading some
critics to argue that it removes the individual from personality considerations.

- Mechanical application: At times, the approach is applied mechanically, lacking nuance and individualization in
treatment.

- Controlled conditions: The approach is best demonstrated under controlled conditions, which may be
challenging to replicate in real-world counseling settings.

- Neglects past and unconscious factors: It ignores the client's past history and unconscious forces that may
contribute to present behavior.

- Overlooks developmental stages: The approach does not adequately consider developmental stages, potentially
missing crucial factors in understanding behavior.
- Emphasis on minimum standards: The approach may program clients toward minimum or tolerable levels of
behavior, potentially stifling creativity and ignoring deeper needs for self-fulfillment, self-actualization, and
feelings of self-worth.