CBT techniques to determine the most effective
components of this approach that seem to be most
strongly associated with symptom reduction. Conse-
quently, it cannot be ruled out that other, nonbe-
havioral aspects of therapy are actually as responsible
for symptom relief as the techniques that are the
focus of CBT treatment (Goldfried & Davison,
1994). For instance, is systematic desensitization the
technique thatcausesanxiety symptom reduction, or
is it perhaps the therapeutic alliance between the
therapist and patient that occurs during systematic
desensitization that is more efficacious?
Dehumanizing? Among the more durable char-
acterizations of the behavioral movement are“ster-
ile,”“mechanistic,” and “dehumanizing.” To
demonstrate that there is real labeling bias operating
here, Woolfolk, Woolfolk, and Wilson (1977)
asked two groups of undergraduates to view iden-
tical videotapes of a teacher using reinforcement
methods. The first group was told that the tape
illustrated behavior modification; for the second
group, the tape was labeled as an illustration of
humanistic education. A subsequent questionnaire
revealed that when the tape was described in
humanistic terms, the teacher on the tape received
significantly better ratings and the teaching method
depicted was seen as significantly more likely to
promote learning and emotional growth.
The use of mechanistic-sounding terms such as
response, stimulus, reinforcement, andoperantneed not
imply that either the therapist or the method is
detached, sterile, or dehumanizing. The systematic
use of learning principles and the examination of
animal analogues for simple illustrations to highlight
the nature of human learning should not lead to a
facile inference that behavior therapists are cold,
manipulating robots whose interests lie more in
their learning principles than in their clients. Ideally,
with the increasing cognitive orientation, such
erroneous images will begin to fade.
Although nothing inherent in behavior therapy
should lead one to conclude that it is necessarily
dehumanizing, its early history provided a few
unfortunate episodes and a considerable stridency
of rhetoric. We have already commented on the
use of aversion techniques that many regarded as
more akin to sadism than therapy, for example. In
the final analysis, no technology or set of principles
is going to permit clinicians the luxury of giving up
their clinical sensitivity.Inner Growth. CBT has also been criticized as
ameliorative but not productive of any inner growth.
It has been said to relieve symptoms or provide a few
skills while failing to offer fulfilling creative experi-
ences. Although it may alter behavior, it falls short of
promoting understanding. It leaves out the inner
person, values, responsibility, and motives. Again,
though not completely off the mark, such criticisms
are less appropriate for the cognitive aspects of CBT,
an emphasis that does deal with mediating variables
such as expectancies and self-concepts—as long as
these are objectively describable and are inferred
from specific stimuli and responses.Manipulation and Control. One of the most
volatile, emotion-laden criticisms of CBT centers
on the issue of manipulation and control. The argu-
ment seems to be that cognitive-behavior therapies
represent insidious and often direct assaults on the
patient’s capacity to make decisions, assume respon-
sibility, and maintain dignity and integrity. But
patients typically seek professional assistance volun-
tarily, thereby acknowledging their need for help
and guidance in altering their lives. Thus, the patient
does have the opportunity to accept or reject the
procedures offered (though this defense may not
apply as well in institutional settings). Further,
many CBT techniques are aimed at helping patients
establish skills that will lead to greater self-direction
and self-control (Goldfried & Davison, 1994).Generalization. A particularly damaging criticism
of several forms of CBT concerns their effectiveness
in settings other than those in which they are con-
ducted. In other words, do the effects of CBT pro-
grams generalize beyond the situations in which they
are practiced? Again, in the interests of evenhanded-
ness, it should be pointed out that most forms of
psychotherapy are subject to the same question.
For example, some patients show a marked426 CHAPTER 14