than the administration of aversive agents or covert
sensitization. For example,response costis a tech-
nique in which positive reinforcers (e.g., tokens in
a token economy system) are removed following an
undesired response (e.g., a temper tantrum) made
by a patient (Spiegler & Guevremont, 2010).
Another example is a technique calledovercorrection.
Here, the idea is that having the patient or client
“overcorrect” the consequences of an act will
make the behavior less likely to recur (Spiegler &
Guevremont, 2010). For example, an adolescent
who has used a marker to write“Screw you, Dad”
on a bedroom wall might be required to apply a
fresh coat of paint to all the walls of the bedroom.
Second Thoughts. Prominent behaviorists (e.g.,
Skinner) have questioned the effectiveness of pun-
ishment in influencing and controlling behavior,
and many clinicians have de-emphasized aversion
methods in their behavioral therapy approaches.
Lazarus (1971a), for example, stated that the build-
ing of better response repertoires and the reduction
of anxiety produce longer-lasting results than do
aversion techniques. Thus, it may turn out that, in
the long run, it is more efficient to deal with a
sexual fetish by reducing the patient’s fear of het-
erosexual behaviors through behavior rehearsal than
by punishing him each time he visualizes a pair of
women’s shoes.
Many critics, both within and without the
behavior therapy movement, have been highly crit-
ical of aversion therapy. The concentration on
punishment and the use of what are sometimes ter-
rifying stimuli often seem totally incompatible with
human dignity. Whether or not patients present
themselves voluntarily for treatment is beside
the point. Such techniques as inducing vomiting,
using a curare-like drug so that the patient will
experience the sensation of suffocating, or injecting
stale smoke into the nostrils seem better relegated to
the status of torture than dignified as treatment.
Others, however, maintain that aversive tech-
niques, used in a sensitive fashion by reputable pro-
fessionals, have real merit. Most often, aversive
techniques are used after everything else has failed.
Furthermore, patients are not dragged kicking and
screaming into the situation. Usually, the proce-
dures are applied to people who have seriously
debilitating problems (alcoholism, excessive smok-
ing, sexual deviations) and who are in despair
because nothing else has worked. Spiegler and
Guevremont (2010) remind us to keep several addi-
tional points in mind as we are evaluating the ethics
of aversion therapy: (a) The aversive stimulus is of
relatively brief duration and does not have long-
lasting effect; and (b) clients are not required to
engage in this treatment but do so by choice.
Such people voluntarily undertake aversion therapy
as the lesser evil—in the same spirit, perhaps, that
one submits yearly to that terrifying“torture”at the
hands of a friendly dentist.Cognitive-Behavioral Therapy
Background
A cognitive perspective on clinical problems
emphasizes the role of thinking in the etiology
and maintenance of problems. Cognitive therapy
seeks to modify or change patterns of thinking
that are believed to contribute to a patient’s prob-
lems. These techniques have a great deal of empiri-
cal support (Hollon & Beck, 1994, 2004; Smith,
Glass, & Miller, 1980; Tolin, 2010) and in combi-
nation with behavioral approaches (i.e., CBT)
are seen as among the most efficacious of all psy-
chological interventions. For example, cognitive-
behavioral treatments dominate the most recent
list of examples of empirically supported treatment
(Chambless et al., 1998; Chambless & Ollendick,
2001; Chorpita et al., 2011), and they have been
shown to be equal or superior to alternative psy-
chological or psychopharmacological treatments for
adults (DeRubeis & Crits-Christoph, 1998; Tolin,
2010) and for children and adolescents (Chorpita
et al., 2011; Kazdin & Weisz, 1998). Most large-
scale clinical trials examining the effects of psycho-
therapy and/or pharmacotherapy have revealed that
the combination of both approaches offers more
significant symptom reduction than either alone
(e.g., Rhode et al., 2008).412 CHAPTER 14