On the much discussed nature of the term “Behavior therapy”

BEHAVIOR THERAPY 9, 89-98 (1978)

On the Much Discussed Nature of the Term "Behavior Therapy" G . TERENCE WILSON

Rutgers University A brief analysis of the historical development of the term behavior therapy is provided, noting its relationship to the term behavior modification. The many meanings that attach to the term behavior therapy are mentioned and the ways in which the term has been used are summarized. Although it has been suggested that the term be abandoned because of its imprecision and dogma-like connotation, the immediate prospect points to its continued use.

In his authoritative text, Bandura (1969) suggested that the term behavior therapy, like psychotherapy, was an "ill-defined partisan label," the use of which "beclouds most of the fundamental issues in the field" (pp. 463 and 464). He recommended that both terms be retired from usage and replaced by dispassionate scientific investigation of the basic mechanisms through which behavioral changes are produced. Yet both are alive and well. In view of the massive influence of Bandura's book on theory, research, and practice in clinical psychology, its failure to alter the labeling lingo in the field arouses curiosity. Recently, Krasner (1976) has announced the death of behavior modification, a term that has been frequently used synonymously with behavior therapy. Of course, it remains to be seen whether he who giveth (Uilmann & Krasner, 1965~ can taketh away. ~ Yet, assuming behavior modification is dead, can the demise of behavior therapy be far behind? Krasner himself rejects the domino theory of semantic collapse and predicts that the death will breathe life into other reifications. Behavior modification is dead, long live behavior therapy. It might be worthwhile to examine the history and development of the term behavior therapy, Written while the author was a Fellow at the Center for Advanced Study in the Behavioral Sciences, Stanford, CA 94305. Requests for reprints should be sent to the author at Rutgers University, P.O. Box 819, Piscataway, NJ 08854. x The recent emergence of a new journal, Behavior Modification, suggests that the corpse is not yet cold. 89 0005-7894/78/0091-0089501.00/0 Copyright(~ 1978by Associationfor Advancementof BehaviorTherapy. All rightsof reproductionin any formreserved.

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exploring its shifting relationship with behavior modification so as to speculate better about its destiny. 2 It was in its blooming adolescence that the term behavior therapy was discovered to have had a stormy birth. (Some say this belies the alleged ahistorical nature of the field.) For a while, the first usage of the term behavior therapy was commonly credited to Eysenck's (1959) paper in which he defined it as the application of modern learning theory to clinical disorders and subsumed psychotherapy, "shorn of its inessential and irrelevant parts," as part thereof. This conception formed the basis for the publication of the first journal devoted exclusively to behavior therapy, Behaviour Research and Therapy, "~by Eysenck and Rachman in London in 1963. Lazarus (1971) then pointed out that he first used the terms behavior therapy and behavior therapist in print to emphasize "the need for adding objective, laboratory-derived therapeutic tools to more orthodox psychotherapeutic techniques" (Lazarus, 1958). Finally, it was established (Krasner, 1971) that Lindsley, Skinner, and Solomon (1953) first used the term behavior therapy to describe their application of operant conditioning research with psychotic patients. And in another (widely rejected) development, Yates (1970) asserted that behavior therapy (in principle if not in name) was developed at the Maudsley Hospital during the early 1950s not under Eysenck but under Shapiro and was defined not by learning theory but by the experimental study of the individual patient. However, this was not the now familiar single-subject methodology of operant conditioning but an essentially correlative approach. Although there were basic commonalities among these positions, hindsight has revealed the important differences inherent in these approaches. An accommodation of interests but not an identity of views was apparent during the late 1950s and much of the 1960s as proponents of these positions rallied around in concerted opposition to the common foe, the psychoanalytic establishment. However, as behavior therapy won its childhood struggle for survival and entered its phase of often grudgingly accepted adolescence toward the end of the 1960s, it began to show increasing willingness to be self-critical. And differences that had always been present began to emerge. In 1966, the Association for Advancement of the Behavior Therapies 2 This exercise doubtless might be interpreted to indicate Krasner's (1976) perspicacity in predicting that the "'beloved games" that adherents of behavior modification played shall survive the term's demise. 3 In the first issue of this journal, Wolpe 0963) argued that the termpsychotherapy should be retained to designate psychologically based treatments as a whole and that "'behavior therapy should be seen as the class of psychotherapeutic practices in which behavior is deployed in a manner designed directly to bring about change in specific habits" (p. 23).

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was founded. This interest group, that subsequently spawned the journal

Behavior Therapy, changed its name to the Association for Advancement of Behavior Therapy (AABT) in 1968, primarily in response to Wilson and Evans' (1967) objection to the use of the term "behavior therapies" (see Franks, 1969). In essence, this was a restatement of Eysenck's position that, though there were many behavioral treatment techniques, they were derived from a common core of learning principles. The singular form of the term was advocated to reflect an alleged conceptual unity. Only 9 years later, it should be noted that the AABT is seriously considering a proposal to move to a divisional organizational structure so as to accommodate the increasingly divergent views and interests of its members. And it has even been suggested that the name of the organization be altered. Back in 1966, Kanfer and Phillips classified four types of behavior therapy: interactive therapy, instigation therapy, replication therapy, and intervention therapy. This terminology has received little press, however. The year 1968 marked the publication of the Journal of Applied Behavior Analysis (JABA), the logical outgrowth of those within the Skinnerian mold who sought to apply operant conditioning procedures to diverse behavior of social importance. Many if not most of those steeped in this tradition rejected the term behavior therapy in part because the term "therapy" smacked of the medical model. Most important, behavior therapy as defined by the AABT and the journal at that time, Behaviour Research and Therapy, departed from narrow operant strictures by admitting the role of unobservable mediating processes in behavior. The term applied behavior analysis was used to dissociate this approach from the statistical analysis of experimental behavior (Goldiamond, 1974). Only 8 years later, the appearance of group designs and even statistical analyses in JABA should be noted. It was in their influential 1965 volume that Ullmann and Krasner used the term behavior modification synonymously with behavior therapy. By 1969, they assigned behavior modification a more generic sense, having it subsume both behavior therapy and evocative therapy as specific forms of clinical intervention procedures. There followed several attempts to distinguish between the two terms. Keehn and Webster (1969) suggested that behavior therapy represented an S - O - R paradigm and behavior modification a nonmediational S - R paradigm. This identification of behavior therapy with counterconditioning [an elusive term in its own right (Evans & Wilson, 1968)] methods and behavior modification with operant methods has been quite common (e.g., Rimm & Masters, 1974), contrary to the Ullmann and Krasner usage. Franzini and Tilker (1972) offered another way out of what they called "the terminological wilderness." They suggested that the distinction might be made according to the nature of the target population. Thus, behavior therapy would refer to the indi-

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vidually tailored treatment of a single client, whereas behavior modification would entail efforts to change social institutions or groups of people without regard to individual learning histories. The surge of interest in the application of operant conditioning methods gave rise to a series of technological terms variously depicting the therapist as a behavioral engineer, a reinforcement machine, and a behavior shaper or programmer. Contingency management was another term. Goldiamond (1974) notes that Keller suggested the use of the term "con-men" and that Malott (1971) created a comic book character with that name. Several nonbehaviorai people have suggested that these ~'con-men" be taken at their own word! In keeping with their own metaphors emphasizing control, strict applied behavior analysts have been regarded as impersonal and mechanistic (Woolfolk, Woolfolk, & Wilson, 1977). As Bandura (Note 1) observes, radical behaviorists "would do well to show greater concern for the propriety and social consequences of their language. Not only does it generate needless public alarm, but the language of coercion may encourage coercive conduct in those who interpret it literally." It is ironic, therefore, that in upbraiding those who would use such nonoperant terms as "self-reinforcement," Catania (1975) reminded us that "the language of behavior has consequences." Humanizing the operant argot need not compromise scientific accuracy. Mahoney (1976) argues that the use of "selfy" terms creates no problem provided clear operational definitions are provided. IfJABA represented the logical development of the ideas implicit in the initial Lindsley et al. (1953) status report, the first use of the term "broad spectrum behavior therapy" by Lazarus (1966) made more explicit the importance he had always attached to the broader clinical variables in therapy. Thus, the nature of the therapeutic relationship, the use of multiple techniques, and the intervention along multiple dimensions of the client's problem(s) were emphasized. Although Lazarus (1965) initially retained a neo-Hullian learning framework in articulating the broad spectrum view, he soon abandoned this theoretical perspective. He adopted a more cognitive viewpoint, advocated the role of "technical eclecticism," and assailed the S - R theory that had been the bedrock of behavior therapy in the late 1950s as simplistic and even clinically sterile. And he labeled the consistent attempts of Eysenck and Wolpe to define behavior therapy in terms of conditioning principles as "narrow band behavior therapy" (Lazarus, 1971). Franks (1969) noted that "broad-spectrum behavior therapy" was defined "more in terms of what the nonbehavior therapist omits than in terms of any set of positive principles espoused by the behavior therapist per se" (p. 19). And Eysenck (1970) and Wolpe (1969) declared that broad spectrum behavior therapy was not behavior

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therapy at all but a "verbal artifice" that subsumed an eclectic mish-mash of theories and techniques that would generate "semantic muddle" (Wolpe, 1971). The terms "broad spectrum" and "narrow band" were the first of many qualifiers that were to be attached to "behavior therapy," a term apparently felt to be too denotatively deficient, if not connotatively constricted, to stand on its own two feet (or four, according to those critics who stress its origin in the animal conditioning laboratory). Lazarus (1976) himself has since described a "multimodal behavior therapy" that he maintains goes beyond broad spectrum behavior therapy in scope and efficacy. Reflecting his constant emphasis on clinical practice, Lazarus (1972) also used the term "clinical behavior therapy." In the same letters and in a somewhat similar spirit, Goldfried and Davison (1976) entitled their book Clinical behavior therapy in an attempt to bridge "the distance between written descriptions of behavior therapy and what occurs in practice." In further attempts to clarify the nature of behavior therapy, Wolpe (1968) emphasized that "a behavior therapist is a behaviorist who does behavior therapy." Yet Locke (1971) argued that, far from being behavioristic, Wolpe's methods "contradicted every major premise of behaviorism." Mahoney, Kazdin, and Lesswing (1974) concluded that methodological but not metaphysical behaviorism is the stuff of which behavior therapy is made. Eysenck (1976) agrees, asserting that there are many different definitions of behaviorism of which Locke's is unacceptable to behavior therapists. The issue, Eysenck suggests, "is a purely verbal, definitional one, rather, than a factual one. To think in these terms merely obfuscates the real issues, and it might be best to forget the term 'behaviorism' altogether in talking about behavior therapy" (p. 337). If psychology has "gone cognitive" (Dember, 1974), most of behavior therapy has followed suit (Mahoney & Arnkoff, in press). Cognitive behavior therapy (the hyphen may be included on occasion) is the newest hybrid term to emerge, marking an inaugural convention in New York in April 1976. Meichenbaum (1974), one of the leading exponents of this approach, has used the term cognitive behavior modification to describe the use of procedures such as self-instructional training in the modification of maladaptive cognitive processes. This suggests a "symbolic" reincarnation for Krasner's (1976) "dear departed." The term cognitive behavior modification had been used earlier by Staats, Minke, Goodwin, and Landeen (1967). 4 Unlike current usage that emphasizes cognitive processes as the mechanisms of therapeutic change, Staats et al. used the term to refer to the modification of a cognitive deficit, reading ability, as a 4 Alan Kazdin brought this to my attention.

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treatment target. In fact, an extrinsic motivational system (token economy) was the behavioral procedure used to improve reading deficits. Staats (1972) tried the term language behavior therapy to describe how verbal communications from the therapist regarding the client's behavior can result in cognitive relabeling and altered reasoning patterns in that individual. Although the term never stuck, this strategy is very much part of current cognitive behavior therapy. The most prominent of the cognitive therapies that did until recently exist outside the mainstream of behavior therapy is Ellis' (1962) rationalemotive therapy (RET). Under the influence of RET, the terms rational behavior therapy and rational behavioral treatment have been coined (e.g., Maultsby, Stiefel, & Brosky, 1972). And Goldfried, Decenteceo, and Weinberg (1974) have described systematic rational restructuring as a technique of cognitive behavior therapy. However, Ellis (1973) does not regard cognitive behavior therapy and rational therapy as synonymous. Indeed, Mahoney and Arnkoff (in press) observe that proponents of what they have labeled the "cognitive learning perspective," while "sharing some rather basic assumptions . . . . range widely in their specific emphasis and procedures." Unlike psychology, Wolpe (1976) has not "gone cognitive." Labeling Meichenbaum and Ellis as "malcontents," i.e., "critics of behavior therapy whose criticisms are attributable to inadequacies in their understanding of it," he accuses them of "cognitive exclusivism." So-called cognitive therapy, according to Wolpe, is simply a subclass of behavior therapy. Of course, applied behavior analysis to which mediational constructs of any kind, cognitive or otherwise, are anathema disdains any dalliance with cognitive behavior therapy. Witness Catania's (1975), Goldiamond's (1976), and Rachlin's (1974) rejections of self-reinforcement, a key concept of the cognitive learning perspective, as an explanatory fiction. Some perennial paper can always be counted on to propose a merger between behavioral and psychodynamic concepts. This desire is reflected in the curious terms psychobehavioral therapy (Woody, 1968) and psychodynamic behavior therapy (Feather & Rhoads, 1972). It is not without significance that behavior therapists of all persuasions, despite their frequently fundamental within-group disagreements noted above, have uniformly rejected attempts to integrate behavioral and psychodynamic principles. Despite the difficulty in defining what behavior therapy is, there is less difficulty in describing what it is not. Clearly, behavior therapy means different things to different people. ~It is not, nor was it ever, a monolithic structure. The current picture is one Or as Franks (1969) put it in using the term to illustrate the telegrammatic nature of Pavlov's second signal system, '~there is both diversity and complexity of meaning to the words "behavior therapist' " (p. 8).

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of vigorous, free-wheeling debate rather than that of a crumbling edifice. There is little point in trying to paper over the cracks of diversity by inventing yet another hybrid term, such a s " (qualifier deleted) behavior therapy." The common core that does exist, a commitment to measurement, methodology, concepts, and procedures derivable from experimental psychology, provides the means of following Bandura's (1969) recommendation. The social learning framework Bandura (1974) has proposed is one attempt to integrate conditioning principles and experimentally demonstrated cognitive learning processes into a coherent body of concepts and procedures for clinical behavior change. In becoming broadly responsive to continuing developments in scientific psychology, behavior therapy will perhaps attain a mature adulthood in the 1970s. To the extent that applied behavior analysis fails to recognize the fundamental importance of mediating processes in human behavior and rigidly restricts itself to the application of a limited number of reinforcement principles to only observable behavior, it will become increasingly irrelevant to clinical practice. Yet, it is unlikely that the label behavior therapy will fall into disuse in the foreseeable future. As with scientific theories or paradigms, a psychological label such as this tends to attain something of an autonomous existence and is only dropped when an alternative label is found to replace it. No likely contender is in sight. Ideally, therapy brand names would become unnecessary to the degree that there is consensus on experimentally validated applications and outcomes. That is a distant goal, and in the meantime those who seek to ground their thinking and practice in the findings of experimental psychology will want some way of distinguishing their endeavors from the bewildering array of therapists who ignore the scientific discipline of psychology. At the risk of being sentimental, as far as brand names go, behavior therapy has had much to recommend it. It was useful in providing the flag around which a variety of intellectual forces rallied in changing the face of much of clinical practice. Although not all may agree with Krasner (1971) that it represented a scientific revolution in the Kuhnian context, friend and foe alike have acknowledged the profound impact behavior therapy has had on the field within so short a time span. Moreover, as a label it does not seem to have exercised an unduly restrictive effect on scientific development. If a thousand flowers did not bloom, several distinctive emphases or divisions did develop, undoubtedly nurtured by the overall spirit of critical, including self-critical, enquiry of most of those who aligned themselves with behavior therapy. The balance between destructive rivalry and a healthy diversity of views is often a delicate one, and it remains to be seen which course behavior therapy will pursue. Despite (or possibly because of?) its elusiveness, behavior therapy might still be helpful, keeping the field broad enough to be representative of new de-

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v e l o p m e n t s but n a r r o w e n o u g h to be useful. After all, were it to be a b a n d o n e d , several critics will have lost s o m e t h i n g to m i s i n t e r p r e t , a n d at least three j o u r n a l s , n u m e r o u s b o o k s , a n d one A n n u a l R e v i e w series will be put out.

REFERENCE NOTE 1. Bandura, A. Value orientations in behavior modification. Unpublished manuscript, Stanford University, 1975.

REFERENCES Bandura, A. Principles of behavior modification. New York: Holt, Rinehart & Winston, 1969. Bandura, A. Behavior theory and models of man. American Psychologist, 1974, 29, 859869. Catania, C. A. The myth of self-reinforcement. Behaviorism, 1975, 3, 192-199. Dember, W. N. Motivation and the cognitive revolution. American Psychologist, 1974, 29, 161-168. Ellis, A. Reason and emotion in psychotherapy. New York: Lyle Stuart, 1962. Ellis, A. Are cognitive behavior therapy and rational therapy synonymous? Rational Living, 1973, 8, 8-11. Evans, W. I., & Wilson, G. T. Note on the terminological confusion surrounding systematic desensitization. Psychological Reports, 1968, 22, 187-191. Eysenck, H. J. Learning theory and behaviour therapy. Journal of Mental Science, 1959, 195, 61-75. Eysenck, H. J. Behaviour therapy and its critics. Journal of Behavior Therapy and Experimental Psychiatry, 1970, 1, 5-15. Eysenck, H. J. Behaviour therapy is behaviouristic. Behavior Therapy, 1972, 3, 609-613. Eysenck, H. J. Behaviour therapy--Dogma or applied science. In P. Feldman & A. Broadhurst (Eds.), The experimental bases of behaviour therapy. New York: Wiley, 1976. Feather, B. W., & Rhoads, J. M. Psychodynamic behavior therapy: Theory and rationale. Archives of General Psychiatry, 1972, 26, 496-502. Franks, C. M. Behavior therapy and its Pavlovian origins. In C. M. Franks (Ed.), Behavior therapy: Appraisal and status. New York: McGraw-Hill, 1969. Pp. 1-26. Franzini, L. R., & Tilker, H. A. On the terminological confusion between behavior therapy and behavior modification. Behavior Therapy, 1972, 3, 279-282. Goldfried, M. R., & Davison, G. C. Clinical behavior therapy. New York: Holt, Rinehart & Winston, 1976. Goldfried, M. R., Decenteceo, E. T., & Weinberg, L. Systematic rational restructuring as a self-control technique. Behavior Therapy, 1974, 5, 247-254. Goldiamond, I. Toward a constructional approach to social problems. Ethical and constitutional issues raised by applied behavior analysis. Behaviorism, 1974, 2, 1-84. Goldiamond, I. Self-reinforcement. Journal of Applied Behavior Analysis, 1976,9, 509-514. Kanfer, F. H., & Phillips, J. S. Behavior therapy: A panacea for all ills or a passing fancy? Archives of General Psychiatry, 1966, 15, 114-128. Keehn, J. D., & Webster, C. D. Behavior therapy and behavior modification. Canadian Journal of Psychology, 1969, 10, 68-73.

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Krasner, L. Behavior therapy. In P. H. Mussen & M. R. Rosenzweig (Eds.), Annual review of psychology. Palo Alto, CA: Annual Reviews, Inc., 1971. Vol. 22, pp. 483-532. Krasner, L. On the death of behavior modification: Some comments from a mourner. American Psychologist, 1976, 31, 387-388. Lazarus, A. A. New methods in psychotherapy: A case study. South African Medical Journal, 1958, 33, 660-664. Lazarus, A. A. Behavior therapy, incomplete treatment, and symptom substitution. Journal of Nervous and Mental Disease, 1965, 140, 80-86. Lazarus, A. A, Broad spectrum behavior therapy and the treatment of agoraphobia. Behaviour Research and Therapy, 1966, 4, 95-97. Lazarus, A. A. Behavior therapy and beyond. New York: McGraw-Hill, 1971. Lazarus, A. A. Clinical behavior therapy. New York: Brunner/Mazel, 1972. Lazarus, A. A. Multimodal behavior therapy. New York: Springer, 1976. Lindsley, O. R., Skinner, B. G., & Solomon, H. C. Studies in behavior therapy. Status report 1. Waltham, MA: Metropolitan State Hospital, 1953. Locke, E. A. Is "behavior therapy" behavioristic? Psychological Bulletin, 1971, 76, 318327. Mahoney, M. J. Terminal terminology: A self-regulated response to Goldiamond. Journal of Applied Behavior Analysis, 1976, 9, 515-517. Mahoney, M. J., & Arnkoff, D. Cognitive and self-control therapies. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change. New York: Wiley, in press. 2nd ed. Mahoney, M. J., Kazdin, A. E., & Lesswing, N. J. Behavior modification: Delusion or deliverance? In C. M. Franks & G. T. Wilson (Eds.), Annual review of behavior therapy theory and practice. New York: Brunner/Mazel, 1974. Vol. 2, pp. 11-40. Malott, R. W. CONtingency MANagement in education and other really exciting places. Kalamazoo, MI: Behaviordelia, 1971. Maultsby, M. C., Stiefel, L., & Brosky, L. A theory of rational behavioral group process. Rational Living, 1972, 7, 28-34. Meichenbaum, D. Cognitive behavior modification. Morristown, NJ: General Learning Press, 1974. Rachlin, H. Self-control. Behaviorism, 1974, 2, 94-107. Rimm, D. C., & Masters, J. C. Behavior therapy. New York: Academic Press, 1974. Staats, A. W. Language behavior therapy: A derivative of social behaviorism. Behavior Therapy, 1972, 3, 165-192. Staats, A. W., Minke, K. A., Goodwin, W., & Landeen, J. Cognitive behavior modification: 'Motivated Learning' reading treatment with subprofessional therapy-technicians. Behaviour Research and Therapy, 1967, 5, 283-299. Ullmann, L. P., & Krasner, L. Case studies in behavior modification. New York: Holt, Rinehart & Winston, 1965, Wilson, G. T., & Evans, W. I. M. Behavior therapy and not the behavior "'therapies." Newsletter of the Association for Advancement of Behavior Therapy, 1967, 2, 5-7. Wolpe, J. Psychotherapy: The nonscientific heritage and the new science. Behaviour Research and Therapy, 1963, 1, 23-28. Wolpe, J. Presidential message. Newsletter of the Association for Advancement of Behavior Therapy, 1968, 3, 1-2. Wolpe, J. The practice of behavior therapy. New York: Pergamon Press, 1969. Wolpe, J. The compass of behavior therapy. Behavior Therapy, 1971, 2, 403-405. Wolpe, J. Behavior therapy and its malcontents. II. Multimodal eclecticism, cognitive exclusivism and "exposure" empiricism. Journal of Behavior Therapy and Experimental Psychiatry, 1976, 7, 10-9116.

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Woody, R. H. Toward a rationale for psychobehavioral therapy. Archives of General Psychiatry, 1968, 19, 197-204. Woolfolk, A. E., Woolfolk, R. L., & Wilson, G. T. A rose by any other n a m e . . . : Labeling bias and attitudes toward behavior modification. Journal of Consulting and Clinical Psychology, 1977, 45, 184--191. Yates, A. J. Behavior therapy. New York: Wiley, 1970. RECEIVED: October 1, 1976; REVISED: January 4, 1977 FINAL ACCEPTANCE:January 12, 1977