meta-analysis presented in Chapter 11 (see Table
11-4). The separate effect sizes calculated for RET,
non-RET cognitive therapies, systematic desen-
sitization, behavior modification, and cognitive-
behavioral therapy indicated that, on average, a
client who received any of these forms of behavior
therapy was functioning better than at least 75% of
those who did not receive any treatment. More
recent meta-analyses have reached similar conclu-
sions across a range of disorders. Further, the major-
ity of meta-analytic studies that have compared the
effectiveness of behavioral or cognitive-behavioral
techniques with that of other forms of psychother-
apy (e.g., psychodynamic or client-centered) have
found a small but consistent superiority for behav-
ioral and cognitive-behavioral methods (Hollon &
Beck, 2004; Svartberg & Stiles, 1991; Tolin, 2010).
Clearly, these are important treatment techniques
for a clinician to master.
Efficiency. The CBT movement also brought
with it a series of techniques that were shorter and
more efficient. The interminable number of 50-
minute psychotherapy hours was replaced by a
much shorter series of consultations that focused
on the patient’s specific complaints. A series of
equally specific procedures was applied, and the
entire process terminated when the patient’s com-
plaints no longer existed. Gone was the everlasting
“rooting out”of underlying pathology, the exhaus-
tive sorting out of the patient’s history, and the
lengthy quest for insight. In their place came an
emphasis on the present and a pragmatism that
was signaled by the use of specific techniques for
specific problems. Because of its efficiency, CBT
may be especially well suited for the managed care
environment.
In fact, some CBT techniques can be imple-
mented by technicians who are trained to work
under the supervision of a doctoral-level clinician.
Thus, not every component of CBT needs to be
executed by Ph.D. personnel. Behavior therapy
programs (e.g., token economies) should be set up
by trained professionals, but their day-to-day exe-
cution can be put in the hands of technicians, para-
professionals, nurses, and others. This constitutes a
considerable savings in mental health personnel and
enables a larger patient population to be reached
than can be treated by the in-depth, one-on-one
procedures of an exclusively psychodynamic
approach.An Array of Evidence-Based Techniques.
Behavior therapy has evolved to the point that it
includes a broad array of techniques, from system-
atic desensitization to cognitive restructuring
(Spiegler & Guevremont, 2010). Unless a CBT
therapist is unalterably committed to a single set
of procedures, this broad spectrum demands that
choices be made. To increase the probability of
making the correct choice, the therapist is likely
to gather information that will best match tech-
nique with patient (Peterson & Sobell, 1994). If
assessment eventually recaptures its position of
prominence in the list of the clinician’s preferred
activities, it will be due in no small measure to
the behavior therapist’s desire for information to
guide the therapeutic decision-making process.
CBT is a very active collection of procedures.
It involves assessment, planning, decisions, and
techniques. In some ways, it may be construed as
a complex technology. A technology cannot be
passively allowed to happen to a patient. It is some-
thing that must be guided with care and foresight
and with great attention to detail. It is not a process
that permits the therapist to wait until the patient
shows up on Thursday before thinking about the
case. The therapist cannot play everything by ear. If
a therapist is using aversion procedures, the time
relationship between the onset of the stimulus and
the onset of punishment may need strict supervi-
sion. Token economies are not haphazard regimens
that can be left to creative, on-the-spot decision
making. Everything must be worked out carefully
in advance. It is important to decide whether the
patient has a behavioral deficit rather than a“pure”
anxiety problem because the therapeutic implica-
tions are vastly different in the two cases.
None of this is meant to imply that every
psychodynamically oriented psychotherapist fails
to think about cases between therapy sessions or
always makes up strategy spontaneously along thePSYCHOTHERAPY: BEHAVIORAL AND COGNITIVE-BEHAVIORAL PERSPECTIVES 421