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A Psychotherapist Engages in Behaviour Therapy

The article reviews clinical findings that led an experienced psychotherapist to favour behaviour therapy over psychotherapy for patients who have anxiety disorders involving avoidance of specific situations or avoidance of specific activities. It is maintained that anxiety disorders are best treated through psychotherapy when they are demonstrably connected to disturbances in interpersonal relations. Three basic procedures in behaviour therapy are described: desensitization, direct exposure, and cognitive restructuring. Transference patterns in each of these procedures are delineated. A fourth procedure, “clinical bargaining,” helps patients relinquish avoidances by experimenting with new behaviours outside the consulting room. Selected aspects of transference and counter-transference in clinical bargaining are discussed. In dealing with single patients, it is recommended that clinicians separate the non directive position of the psychotherapist from the directive role of the behaviour therapist, since these two roles are largely irreconcilable.