Please see attached.
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Chapter 10 Behavioral
Interventions
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Purpose of This
Chapter
Most of our behavior is not new behavior. In fact, most of our
behavior patterns, whether they are how we put on our shoes,
eat our meals, walk the dog, or pay our bills, have such a
history that we probably can’t remember why we started
doing them the way we do. These behavior patterns have
power in our lives—power to make our lives less complicated,
and a competing power to make us more resistant to
change. In this chapter, we examine how persons change
patterns of behavior that have become dysfunctional, less
effective, or even unnecessary. Some patterns relate to
behaviors that interfere with a client’s goals, hopes, or needs;
others are behaviors that might be missing from a client’s
patterns of interaction, leading to a failure to achieve desired
goals, hopes, or needs. Perhaps the most important aspect
of this chapter is the emphasis on a client’s responsibility in
this process of change, and how the client and counselor
work together to accomplish the client’s objectives. A variety
of symptoms can be treated using the behavioral
interventions described in this chapter, including affective
symptoms such as phobic responses, cognitive symptoms
such as compulsive thought patterns, and
behavioral/systemic patterns.
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Considerations as You Read This
Chapter
Behavior is the part of human existence that communicates to others
how a person feels, what a person thinks, and who a person is. Because
it is available to others through their observations, behavior becomes
the communication channel that connects an individual to other people.
Behavior is the tool or means by which people accomplish, perform, or
in other ways achieve the goals that they set.
Behavior can be the cause of a person’s failures, mistakes, or
disappointments.
Because behavior is the outward manifestation of a person’s inner self,
it may sometimes seem to be unconnected to him or her. Many client
problems involve some manifestation of behavior; often, the best
approach to working with client problems is by addressing behavioral
changes.
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Thus far, we have examined how feelings and thinking are implicated in
human problems, and how affective and cognitive interventions can
alleviate problems. In this chapter, we address problems that are
established in behavior patterns—the things people do, or fail to do.
Behavioral interventions are intended to help clients change their habits
when they interfere with achievement of their goals, ambitions, or values, or
when they contribute to negative outcomes. Behavioral interventions are
based on learning theory. Because of this, behavioral interventions are often
thought of as skill development and to draw upon the teaching aspect
of counseling.
Clients present with a vast range of skill deficits, from some that are mild
and not terribly debilitating to those that are serious and far-reaching. One
example of such a contrast is the middle-age man who wishes he could
stand up to his father. He does not “suffer” from their relationship except
when he is with his father, which only occurs when he travels to his parents’
home for holidays. He is quite satisfied, by contrast, with his relationship to
his wife and children. On the other end of the spectrum, Pinto, Rahman,
and Williams (2014) describe a program to teach recently incarcerated
women advocacy skills, such as learning new interpersonal behaviors as
well as some fundamental skills of leadership, as an important means by
which they can be empowered to succeed after incarceration. Based on the
life situations clients present and the counselor’s willingness to engage in
behavioral interventions, the life skills to be mastered may be life-
enhancing or life-changing.
Although a large number of interventions can be classified as behavioral in
nature and focus, perhaps the most common ones include imitation
learning (social modeling), skills training (including behavioral rehearsal or
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role-playing), relaxation training, systematic desensitization, and self-
management exercises.
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Behaviorial Interventions and
Theory
Most behavioral interventions can be traced back to three originating
schools of behavioral thought: Pavlov’s original conceptualizations, called
classical conditioning; B. F. Skinner’s later modifications of Pavlov’s work,
known as operant conditioning; and Albert Bandura’s additions to these
approaches, referred to as social modeling.
The classical conditioning model was based on Pavlov’s animal
experiments in which he sought to understand how learning occurs. It
assumed that behavior changes when new conditions in the environment
emerge. When his dogs learned to associate the ringing of the bell at the
gate to their kennels with feeding, they began to anticipate the feeding time
whenever the bell rang. In human terms, the theory holds that when the
smell of pie in the oven typically means the arrival of favorite relatives (and
enjoying a delicious pie), just the aroma can change one’s mood. This
model for learning tended to address very basic human physiological
responses.
B. F. Skinner used the research laboratory to explain more-complicated
learning patterns typical of human behavior. Again, by using animals to
study patterns of learning, he looked at how a behavior or skill is acquired.
He found that newly acquired skills could be refined, enhanced, and shaped
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by the manner in which rewards were given. This approach, called shaping,
is based on the following axiom:
The likelihood of occurrence of any future event is directly related to
the consequences of past similar events.
Most parents have learned that a bedtime story when a child is agreeable
about bedtime is an incentive for the child to be agreeable the next evening.
The child has learned that agreeable behavior is followed by something
pleasant—that is, a reward. Skinner called this operant conditioning. As the
child grows, and especially when parenting challenges occur, it is important
to reward behavior that leans toward the desired goal, whether that is
cleaning one’s room or doing one’s homework. In other words, rewards are
not only paired with a completed task, but with positive steps toward the
completed task as well. Because many behaviors are unlikely to be
changed all at once, this aspect of operant conditioning is an important
one.
Bandura (1969) viewed both Skinner’s and Pavlov’s models as basic but
not complete explanations for how most human learning occurs. He
reasoned that most people learn in a “safe” way—by observing other people
learning and then imitating their behavior. Most children have learned that
this really works—that is, copying the behavior of others who seem to gain
the approval of adults. Bandura called this approach social learning. It has
also been referred to as observational learning, vicarious learning, and
imitation learning. It is based on the use of a model—someone or
something—to observe carefully and then imitate. The more influential the
model, the more quickly learning occurs. Therefore, children tend to follow
other children they deem as attractive models; adults are influenced by
advertisements that include favorite athletes or popular entertainment
personalities.
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All three of these approaches are based on experimental study of human
learning. People use all three of these patterns when they learn something
new; therefore, it makes some sense that these learning approaches might
also be viable when behavior change is called for. This is the rationale for
introducing behavioral interventions into the counseling process.
Behavioral interventions share certain common assumptions and elements:
Maladaptive behavior (behavior that produces undesirable personal or
social consequences) is often the result of learning.
Maladaptive behavior can be weakened or eliminated, and adaptive
behavior can be strengthened or increased through the use of learning
principles.
Behavior (adaptive or maladaptive) occurs in specific situations and is
functionally related to specific events that both precede and follow
these situations. For example, a client may be aggressive in some
situations without being aggressive in most situations. Thus, behavioral
practitioners attempt to avoid labeling clients using such arbitrary
descriptors as aggressive. Instead, emphasis is placed on what a client
does or does not do that is aggressive, and what situational events cue
or precipitate the aggressive response, as well as events that strengthen
or weaken the aggressive response.
Clearly defined outline or treatment goals are important for the overall
efficiency of these interventions and are defined individually for each
client.
Behavioral interventions focus on the present rather than the past or
future and are selected and tailored to each client’s set of problems and
concerns.
Characteristics of clients who seem to have the most success with
behavioral interventions include
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A strong goal orientation—people who are motivated by achieving goals
or getting results
An action orientation—people who have a need to be active, goal-
focused, and participating in the helping process
An interest in changing a discrete and limited (two to three) number of
behaviors
Behavioral interventions have also been used extensively and found to be
very suitable in schools, mental health agencies, or situations with time-
limited counseling.
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Goals of Behavioral
Interventions
Although the definition of the term behavior has expanded in recent years to
include covert or private events such as thoughts, beliefs, and feelings
(when they can be specified clearly), as well as overt events or behaviors
that are observable by others, this chapter is focused primarily on overt
behaviors. The goal of behavioral interventions is to increase what could be
called adaptive behavior—that is, those behaviors that assist the client in
meeting stated goals. In addition to developing new behaviors, a goal of
behavioral interventions may also involve weakening or eliminating
behaviors that work against the desired outcome (e.g., eating unhealthy
snacks when you wish to lose weight).
Behavioral interventions have been used in many different settings (such as
schools, agencies, business and industry, and correctional institutions),
with a great variety of human problems (including learning and academic
problems, motivational and performance problems, marital and sexual
dysfunction, skills deficits, and anxiety), and with maladaptive habits (such
as overeating, smoking, substance abuse, and procrastination). In this
chapter, we focus primarily on the behavioral interventions that seem to be
most useful for working with people in the general population (as opposed
to those in institutional settings). These include social modeling,
behavioral rehearsal and skills-training approaches, relaxation training,
systematic desensitization, and self-management interventions.
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Behavioral Intervention Skills
Behavioral Skills
Describing Behaviors
Helping the client understand the complexity of behavioral tasks;
breaking tasks down into sequential behaviors
Modifying Behaviors
Helping the client change behavior patterns when it is deemed
appropriate
Contracting
Helping the client establish commitments, timelines, and
recordkeeping for change
Supporting and Reinforcing
Helping the client assess and recognize levels of progress toward
goals
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Behavioral Interventions
Social Modeling
Using examples from other sources to teach the client how and what
to change; included in this cluster of interventions are overt
modeling, symbolic modeling, and covert modeling
Role-Play and Rehearsal
Using simulations to examine and rehearse new behaviors, verbal
interactions, and so on; relies on practice and feedback
Anxiety Reduction Methods
Helping client assume control over muscular or kinesthetic
processes as a method to counter learned anxiety responses to
certain stimuli
Symptom Prescription
Helping clients regain control over their behavior by instructing them
to engage the symptom rather than attempt to avoid it
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Self-Management
Helping the client learn how to observe and manage behavior
patterns over time; includes self-monitoring (observing and
recording one’s behavior), self-contracting (making a commitment
to oneself to work on changing behaviors outside of counseling),
and self-reward (learning ways to reward oneself when behavioral
goals are achieved)
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Basic Behavioral Skills
Counselors working on behavioral change use a number of basic skills in
their work that involve ways of conceptualizing behavior and behavior
change. The starting point is the task of describing behavior.
Describing Behaviors
Describing or deconstructing one’s behavior is not as easy as it might
appear. Athletes and their coaches have become adept at behavior
description because they must break behavioral processes down (e.g., a
successful free throw in basketball) into the many sub-behaviors that are
part of the behavior. Thus, their description for a free throw includes how
the athlete’s feet are positioned, the rhythm of the throw, the arc that is
created as the ball approaches the net, and so on.
However, if you are on a basketball team and not successfully converting
many free throws, one of the first things a coach may do is analyze your
present actions and then reconstruct them toward the “model” free throw.
Counselors helping clients make behavioral changes do much the same
thing. Consequently, counselors must understand how to do behavioral
analysis and how to restructure behavior patterns so they can coach their
clients in this change process.
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Modifying Behaviors
As already noted, many people simply do not think behaviorally. Before the
counselor can gain a commitment from clients to enter into behavioral
change processes, the client must recognize the relationship between
certain target behaviors and their consequences. Thus, you might find
yourself saying, “It seems like every time you do this, then that happens. Do
you agree? Because you don’t like it when that happens, perhaps we could
start thinking about ways of breaking the pattern.” Saying this does not
resolve the issue, however. The point is that you will find it necessary to
help clients understand the process of behavior change as well as giving
them strategies to implement change.
Contracting
Several times we have mentioned the importance of gaining client
commitment with counseling goals. One demonstrated way to do this is
the counseling contract. It seems to be a human quality to feel more
committed to a task if a contract is involved. The contract is developed
between the counselor and client. The interesting part about contracting is
that a contract tends to be more effective when the client actually signs his
or her name to it (e.g., Smith, 1994). There is nothing legal about this act,
but psychologically it does seem to make a difference for clients.
Regardless of whether the client signs the contract, writing down the
conditions of the contract together is quite important.
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Supporting and Reinforcing
As clients begin the challenging process of changing behaviors that have
long been part of their repertoire, and thus are familiar, they often need
support and reinforcement. This can be as simple as telling the client, “You
can do it,” or “That was a good effort.” Not to give the client this kind of
feedback may be interpreted by some that they are not doing it right or that
they are failing. It is also possible to overdo these supporting words. If that
happens, the comments begin to lose their effect, or you may be viewed as
having lower standards than the client has.
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Using Behavioral Interventions
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Social Modeling
Much of the work associated with social modeling has been initiated or
stimulated by Bandura (1977). Three approaches, or models, have
emerged: the overt model, the symbolic model, and the covert model. Each
of these approaches can be used in working with clients.
The overt social modeling approach uses one or more persons as a model
to illustrate the behavior to be learned or refined. The overt model may be
live (also called in vivo) or recorded for viewing at a later time. It is overt
because it is apparent that this model is someone to be observed and
imitated.
The symbolic social modeling approach might include animated cartoon or
fantasy characters, schematics, narratives, or slides. A good example is the
training videos produced to help a person learn how to use new computer
software. The process takes the learner through a step-by-step process,
with the ultimate goal that the learner can repeat the process later without
the help of the training video.
The covert modeling approach uses imagination in the learning process. We
noted earlier that this mental process makes covert interventions cognitive
rather than behavioral. However, because so many behavioral counselors
refer to this process, we break our own rule to include it here as well. The
covert model—whether a person, cartoon character, or schematic diagram—
is imagined rather than shown. Covert models may be the client (called
self-modeling) or someone else enacting the behavior with increasing
deftness. Various cues (e.g., specifying sensory images or inner reactions)
can be supplied to support the imagined scenario.
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Live (Overt) Modeling
With live modeling, the desired behavioral response is performed in the
presence of the client. Live models can include the counselor, a teacher in a
developmental guidance class, or a client’s peers in a counseling group.
Usually, the counselor provides a modeled demonstration via a role-play
activity in which he or she takes the part of the client and demonstrates a
different way that the client might respond or behave.
Live modeling can be a most versatile tool for the school counselor, the
rehabilitation counselor, or the family counselor, to name only a few.
Scenarios can vary from helping youth understand how to manage conflict
(by observing a videotape of other youth doing so after an altercation), to
helping long-term unemployed adults whose lives are complicated by a
mental disability learn stronger self-presentation skills (by having
successful persons from the same program agree to present to these
clients), to helping family members see a new way to communicate. The
counselor’s role can vary from being an actor in the modeling exercise to
being the choreographer or being the narrator. What follows is a modeling
session in which the counselor served as narrator. The scene is a group
guidance session involving 12 seventh-graders. The counselor has been
working with 6 of the students on a project, “Using the Library to Learn
about Careers.” The second 6 students are new to the group and are just
beginning the project.
Live modeling is particularly useful in instances in which the client is
assessed as truly lacking a skill set. The modeled demonstration provides
cues that the client can use to acquire
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Using Live Modeling with Middle-School
Students
C��������:
Today, we have some new faces in our group. I think all of you ‐
already know each other. For convenience, I’m going to call you the
“Old-Timers” and you the “New Bunch.” The Old-Timers have been
working on a project to learn about jobs. I’m going to ask them to
demonstrate some of the things they have been doing. We’ll use
something called a fishbowl. What that means is that the Old-Timers
sit in a small circle. The rest of us sit outside the circle and observe
the Old-Timers as they talk about their project. We do this for about
15 minutes and then we trade places. The New Bunch will come into
the inner circle and the Old-Timers will sit around the outside. Any
questions? [Nervous noises, chairs moving, people getting settled.
The Old-Timers are familiar with this exercise. They were introduced
to it when they were in the role of the New Bunch a few weeks
earlier.] Now, if everyone is ready, Old-Timers, I would like for you to
talk to each other about the topic: “Fifty ways to choose a career—all
in the library.”
O��-T�����:
[A discussion begins, slowly at first, about how to use the library
to find out about careers. Diff erent members of the group talk about
how they got started, who in the library helped them find the right
books, which books were most helpful, how they preferred the
computer career software for some of the research, funny things
they discovered about some careers, and so on. There is a lot of
joking. It doesn’t look like a great learning experience, but the point
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is made that learning about jobs can be fun and that the library is a
neat place to get career information. They also learned the process
of approaching the right librarian and knowing what to ask for. After
about 15 minutes, the counselor interrupts, summarizes what was
said, and asks the two groups to trade places. Some groans,
teasing, playful putdowns follow as students change seats.]
C��������:
Now, New Bunch, it’s your turn. I’d like you to show the Old-Timers
what you can do. This time, the topic will be, “Things I am going to
do in the library to learn about jobs.”
N�� B����:
[More groans, jokes, moving of chairs. Talk begins slowly. Someone
makes a joke. All laugh. Finally, someone gets into the spirit and
says she would like to find out about becoming an astronaut.
Everyone laughs. Counselor intervenes, commends student for her
question, challenges group to come up with a plan for using the
library to help her find out about becoming an astronaut. The group
begins, more or less in earnest, and the information that
characterized the first group’s discussion comes out again, this time
focusing on the topic of finding out about becoming an astronaut.]
those new responses to replace those that blocked learning the desired
skill. For example, a client who wishes to be more assertive may benefit
from seeing the counselor or a peer demonstrate such behaviors in role-
played situations. The following exchange between the counselor (model)
and the client (wishing to be more assertive) illustrates how such a session
might go.
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Modeling Assertive Responses
C��������:
Today, Nancy, I thought we might do a role-play—that’s where you
and I enact someone other than ourselves, and our “play” is a
scenario in which you are returning some unusable merchandise to a
local store.
N����:
That sounds awful. I don’t like to have to return things to the store.
C��������:
I know. But you said you wished you could do that sort of thing
without getting turned inside out. Don’t worry. I’m going to play you
and you are going to play the part of the store employee. Okay?
N����: [smiling]
Well, that’s a little better. Okay.
C��������:
You begin first, by asking me if I need some help.
N����:
Hello, can I help you?
[as employee]
[as N����]
C��������:
Yes. I purchased this baptismal gown for my daughter’s baby, but
after the baby was born, my daughter realized it was too small. I’d
like to exchange it if I may.
N����:
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How long ago did you purchase it?
[as employee]
[as Nancy]
C��������:
Two months ago, I’m afraid. I know your return policy is 30 days, but
I hope you will accept it in exchange.
[as employee]
N����:
Well, since you only want to exchange it, I think we can do that.
Following the role-play, the counselor and Nancy discussed the interaction,
and then they conducted a second role-play, this time with Nancy as herself
and the counselor as the store employee. Then they evaluated Nancy’s
performance and identified some ways she could improve. This was
followed by a third role-play in which Nancy again was herself. Her
performance in the third role-play was much improved and she felt
successful. Live modeling in which the client is a participant is limited by
the client’s willingness to participate in an imagined situation as an actor,
unless you and the client can take an impending real situation that both of
you can rehearse. If your client is particularly withdrawn, you may wish to
use other persons as the modeling participants.
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Symbolic Modeling
Although live models have much impact on the client, they are sometimes
difficult to use because the counselor cannot control the accuracy of the
demonstration of the behavior being modeled. To correct for this, many
counselors use symbolic models through video recordings, audio
recordings, or films in which a desired behavior is introduced and ‐
presented. For example, symbolic models could be used with clients who
want to improve their study habits. Reading about effective study habits of
successful people and their scholastic efforts is a first step to help clients
identify desired behaviors. Next, clients can listen to a recording or watch a
video illustrating persons who are studying appropriately. Once effective
symbolic models are developed, they can be stored easily and retrieved for
future use by the same or different clients.
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Covert Modeling
Covert modeling, also called imaging, is a process in which the client ‐
imagines a scene in which the desired behavior is displayed. The imagined
model can be either the client or someone else. The first step is to work out
a script that depicts the situation(s) and desired responses. For example, if
an avoidant client desires to learn to communicate more successfully with
a partner, scenes could be developed in which the client is having a
successful discussion. One scene might be as follows:
It’s Friday night. You would like to go to a movie, but your partner is
very tired. You acknowledge your partner’s tiredness, but suggest
that a movie might prove relaxing as well as entertaining. Your
partner thinks about it for a moment, and then agrees.
Imaging serves two purposes: It brings the appropriate behaviors into
focus, and it serves to construct a success image into the person’s mind.
Both are desired outcomes. This is often used in coaching athletes.
However, the same intervention can be used to coach persons who must
learn to be calmer under stress, to avoid taking that first drink, to bypass a
sarcastic comment to one’s partner, and so forth.
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Characteristics of the Modeled Presentation
The way in which a presentation is modeled can affect the client’s ability to
pay attention to and remember the demonstration. It is important that the
model be presented in a way that engages the client. The first part of the
modeled presentation should include instructions and cues about the
features of the modeled behavior or activity. A rationale for the use of
modeling should also be given to the client prior to the demonstration.
Behaviors to be modeled should minimize the amount of stress that the
client might experience in the presentation. Distressing and anxiety-
provoking stimuli may interfere with the client’s observation powers,
processing, or remembering. For this reason, the counselor should be
checking in with the client frequently regarding the client’s reaction to the
model.
Complex patterns of behavior should be broken down and presented in
smaller and more easily understood sequences. If too many behaviors or
an overly complex model is presented to the client at one time, the
likelihood of learning is greatly diminished. You can seek the client’s input
about the presentation of modeled behaviors to ensure that the ingredients
and pace of the modeled demonstration are presented in a facilitative
manner and to be sure that …
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Applying Interventions to
Dialectical Behavior Therapy
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Behavioral Interventions Used in
Dialectical Behavior Therapy
Dialectical Behavior Therapy (DBT) uses affective and cognitive
interventions, but not because emotional catharsis or insight is the goal;
rather, DBT is founded on the premise that once the client trusts the
therapist adequately and feels validated and understood by the therapist,
the real goal of developing life skills that will offer new and healthier
options for the client becomes evident. Thus, behavioral change is the crux
of DBT, and the word skills is used throughout the DBT literature to describe
the desired outcome of the therapy (Dimeff & Koerner, 2007; Miller,
Rathus, & Linehan, 2007).
For programs that have invested in DBT as their primary delivery method,
group work is often the context for skill development. Therefore, the
portions of this chapter that discuss role-play, behavioral rehearsal, and the
receiving of feedback are descriptive of the interventions used by DBT
therapists in their work. Of course, counselors who align themselves with
DBT tenets can use these same behavioral interventions within individual
counseling. In group work or individual counseling, once the stage of skill
development has been reached in DBT, all of the interventions described in
this chapter could conceivably be used. Each DBT therapist develops his or
her preferred interventions for behavioral change, and the DBT literature
describes the use of a host of such interventions across different clinical
populations. The content of this chapter can serve as a primer for
developing one’s own repertoire.
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Intervention Strategies
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Intervention Strategies
Complete the table below.
Create a 50- to 75-word scenario for a client who is displaying the highlighted behavior intervention. Brainstorm topics or factors that may affect the client when dealing with this situation. What interventions and strategies would you use with this client? Please use peer reviewed sources only
Interventions
Goals
Client Scenario/Factors
Intervention/Strategies
Affective
Cognitive
Behavioral
Systemic
Copyright 2020 by University of Phoenix. All rights reserved.
Copyright 2019 by University of Phoenix. All rights reserved.