Therapist Client Relationships in Behavior Therapy

From the beginning, most behavior therapists have been intensely concerned with the ethical aspects of the application of behavior therapy, the ethical implications of the relationship between therapist and client, and the role of each in treatment. In contrast to other psychotherapeutic approaches, behavior therapy is characterized by a heavy emphasis on the responsibility of the therapist for successful treatment outcome. In behavior therapy, failure to achieve treatment goals is presumed to be the result of therapist errors or environmental hazards beyond the therapist's control, rather than of client resistance. The therapist is viewed as an "expert" guide who brings to the situation a body of teachable knowledge. In collegial fashion, as a mutual collaborative process, the patient is shown how to use this knowledge to bring about desired change. In this view, therapeutic failures result from several sources of therapist error, particularly: (1) errors in selection of therapeutic goals due to inadequate assessment; (2) errors in the selection, teaching, or application of techniques; (3) failure to consider client values in the selection of therapeutic goals, or the placing of societal or therapist values above those of the client in the process of goal selection; and (4) variables beyond the therapist's control.

While early behavior therapists tended to neglect the importance of a workable therapeutic relationship with the client, as the field has evolved such issues have become increasingly important in behavior therapy (see Wilson and Evans). Most behavior therapists recognize that without a therapeutic relationship characterized by mutual respect, empathy, trust, and equality, the first three types of therapist error noted above cannot be avoided, and treatment is unlikely to be successful. An increasing emphasis on thought and feeling leads to recognition that an adequate therapeutic relationship is essential to assessment and treatment. Changes in thoughts and emotions can, in and of themselves, be appropriate outcomes of treatment, as can changes in overt behavior. These changes can be facilitated by the establishment of a good therapeutic relationship.

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