Clinical Psychology

his or her room, it is not likely to be nearly so
effective as a token given immediately. That
token will come to signify reward and will assume
much of the effectiveness of the backup reward for
which it may be exchanged. Of course, for youth it
is important to have rewards that are developmen-
tally meaningful and these rewards cannot be
offered so far in the future that it is difficult for a
young child to understand the relationship between
their behavior and what that behavior has earned.

Aversion Therapy

One of the most controversial of all treatments is
aversion therapy. Actually, this is not a single therapy
but a series of different procedures applied to beha-
viors regarded as undesirable. These applications are
based on the apparently simple principle that when
a response is followed by an unpleasant conse-
quence (e.g., punishment or pain), its strength will
diminish. As Wolpe (1973) put it,“Aversion ther-
apy consists, operationally, of administering an
aversive stimulus to inhibit an unwanted emotional
response, thereby diminishing its habit strength”
(p. 216). An unpleasant stimulus is placed in tem-
poral contiguity with the undesirable behavior. The
idea is that a permanent association between the
undesirable behavior and the unpleasant stimulus
will be forged, and conditioning will take place.
Such techniques may appear to be recent addi-
tions to scientific and clinical repertoires. However,
a little reflection will remind us that they have been
around for eons, often in the form of such unso-
phisticated practices as spanking, “Go to your
room,”and“No TV tonight for you.”Modern
aversive therapy techniques differ from these exam-
ples in at least two important ways. First, the pre-
sentation of the aversive agent is done
systematically. The temporal contiguity is very
carefully monitored. Second, the punishment is
consistently applied. The punishment applied by
parents is often highly inconsistent. Sometimes the
undesirable behavior of the child is immediately
punished. But very often, the parent forgets or is
distracted, too tired, or whatever to respond. As a
result, the child learns that sometimes the behavior

is ignored, and thus extinction fails to occur. As

formal clinical procedures, these techniques have

been applied most often to help patients develop

increased self-control. They have been used to

cope with problems of obesity, smoking, alcohol-

ism, and sexual deviations.

Aversive Agents. Among the aversive agents that

have been used most frequently are electrical stim-

ulation and drugs. For example, strong emetic drugs

have been used aversively for many years (see, e.g.,

Voegtlin & Lemere, 1942), especially in the treat-

ment of alcoholism. The patient is given a drug that

produces nausea or vomiting and then takes a drink

(or the drug may be mixed with the drink). The

patient soon becomes ill. This combination of alco-

hol and emetic is given for a week to 10 days.

Eventually, just the sight of a drink is sufficient to

induce nausea and discomfort.

Wolpe (1973) has described a variety of other

aversive agents, including holding one’s breath, stale

cigarette smoke, vile-smelling solutions of asafetida,

intense illumination, white noise, and shame.

Clearly, the range of potential aversive agents is

limited only by the imagination of resourceful

therapists.

Covert Sensitization. Cautela (1967) developed

a set of procedures, known ascovert sensitization, that

rely on imagery rather than the actual use of pun-

ishment, drugs, or stimulation. Patients are asked to

imagine themselves engaging in the behaviors they

wish to eliminate. Once they have the undesired

behaviors clearly in mind, they are instructed to

imagine extremely aversive events. Some of the

instructions are vivid to say the least. A rather

mild example from the treatment of a case of over-

eating should suffice:“As you touch the fork, you

can feel food particles inching up your throat.

You’re just about to vomit” (Cautela, 1967,

p. 462). The ensuing descriptions become more

graphic.

Other Techniques. Other behavior therapy

techniques, while technically considered forms of

aversion therapy or punishment, are less extreme

PSYCHOTHERAPY: BEHAVIORAL AND COGNITIVE-BEHAVIORAL PERSPECTIVES 411