of reference. Different theorists may use similar tech-
niques for vastly different reasons.
The Technique. According to Goldfried and
Davison (1994), the use of behavior rehearsal
involves four stages. The first stage is to prepare
the patient by explaining the necessity for acquiring
new behaviors, getting the patient to accept behav-
ior rehearsal as a useful device, and reducing any
initial anxiety over the prospect of role-playing.
The second stage involves the selection of target
situations. At this point, many therapists will draw
up a hierarchy of role-playing or rehearsal situa-
tions. This hierarchy should relate directly to situa-
tions in which the patient has been having
difficulty. A sample hierarchy of target situations
(ranked in order of the increasingly complex behav-
ioral skills required) might be as follows:
- You ask a secretary for information about a
class. - You ask a student in class about last week’s
assignment. - After class, you approach the instructor with a
question about the lecture. - You go to the instructor’s office and engage
her in conversation about a certain point. - You purposely engage another student, who
you know disagrees with you, in a minor
debate about some issue.
The third stage is the actual behavior rehearsal.
Moving up the hierarchy, the patient plays the
appropriate roles, with the therapist providing
both coaching and feedback regarding the adequacy
of the patient’s performance. Sometimes videotaped
replays are used as an aid. In other instances, the
therapist (or a therapeutic aide) exchanges roles
with the patient to provide an appropriate model.
When patients develop proficiency in one target
situation, they move up the hierarchy.
The final stage is the patient’s actual utilization of
newly acquired skills in real-life situations. After such
in vivo experiences, the patient and the therapist dis-
cuss the patient’s performance and feelings about the
experiences. Sometimes patients are asked to keep
written records describing the situations they were
in, their behavior, and its consequences.Assertiveness Training. One application of
behavioral rehearsal isassertiveness training. Wolpe
regarded assertive responses as an example of how
reciprocal inhibition works. That is, it is impossible
to behave assertively and to be passive simulta-
neously. Situations that once evoked anxiety will
no longer do so because the assertive behavior in-
hibits the anxiety.
Originally, assertiveness training was designed as
a treatment for persons whose anxiety seemed to
stem from their timid mode of coping with situations
(Wolpe, 1958; Wolpe & Lazarus, 1966). A variety
of assertiveness training programs have been devel-
oped specifically for individuals seeking to overcome
destructive passivity. But assertiveness training has
also been used in treating sexual problems, depres-
sion, and marital conflicts. It is important to note that
cognitive self-statements (e.g.,“I was thinking that
I am perfectly free to say no”) may enhance the
effects of assertiveness training. In fact, many proce-
dures can be used to increase assertiveness. Behavior
rehearsal is perhaps the most obvious one.
Lack of assertiveness may stem from a variety of
sources. In some cases, the cause may be a simple lack
of information, in which case the treatment might
center largely on providing information. In other
instances, a kind of anticipatory anxiety may prevent
persons from behaving assertively. In such cases, the
treatment may involve desensitization. Yet other indi-
viduals may have unrealistic (negative) expectations
about what will ensue if they become assertive.
Some clinicians would deal with such expectations
through interpretation or rational-emotive tech-
niques. Similar techniques might be applied to
patients who feel that assertiveness is wrong. Finally,
there are patients whose lack of assertiveness involves a
behavioral deficit—they do not know how to behave
assertively. For such patients, behavior rehearsal,
modeling, and related procedures would be used.
Assertiveness training is not the same as trying to
teach people to be aggressive. It is really a method of
training people to express how they feel without
trampling on the rights of others in the processPSYCHOTHERAPY: BEHAVIORAL AND COGNITIVE-BEHAVIORAL PERSPECTIVES 409