A Psychotherapist's Note on Behaviour Therapy

Abstract

To an analytically oriented psychiatrist a neurotic symptom is a meaningful expression or result of an unconscious conflict. To a behavioural therapist it is maladaptive, learned behaviour. The psychotherapist sees his task as a joint venture in which patient and therapist explore the patient's life history in order to determine how the trauma of the past manifests itself in the distortions of the present. Behavioural therapists contend that analytical theory, of whatever sort, is invalidated by their successes and by the fact that successful treatment of a symptom or set of symptoms has not, in their experience, led to substitution of some other symptom or to more serious pathological consequences. The claimed success rate for behaviour therapy is very high. Journals of recent years abound in reports of spectacular cures, especially of individual patients with traditionally refractory conditions (Clark, 1963; Cooper, A. J., 1963, 1965; Raymond and O'Keefe, 1965). The psychotherapist's aim is to help his patient to understand his problems and find his own solutions for them. Would he be better advised to use his authority to reward “acceptable” and punish “unacceptable” behaviour; or his imagination and inventive skill to figure out ever more ingenious procedures of deconditioning? Is the time-consuming process of intensive psychotherapy not only wasteful but inferior in results to techniques based on conditioning? It seems to me, to judge by recent reports, that some of the results of behaviour therapy are less impressive than a cursory reading would suggest.