Private Practice of Behavioral Treatment

Therapeutic Relationship

While in the early days of behavior therapy, the importance of the therapist-client relationship was de-emphasized, current behavior therapists view the quality of this relationship as quite important to successful treatment outcome. For example, David Burns has shown in his research that clients' perceptions of the therapist's empathy contribute significantly to the outcome of cognitive-behavioral therapy (CBT) for depression. Compared with therapists of other therapeutic orientations, however, behavior therapists do not see the therapeutic relationship as the most important factor, but rather they still believe that specific behavioral interventions are most important. Clearly, in our private practice, we try to establish a solid therapeutic working alliance. In addition to the possibility that this may be therapeutic in itself, we believe that such alliance is often necessary to get clients to engage in therapeutic tasks that are uncomfortable and time-consuming, including exposure and response prevention for obsessive-compulsive disorder (OCD).

Behavioral Assessment

As for behavioral assessment, we rely primarily on reliable and valid self-report measures. Most of these measures have been used in randomized controlled trials (i.e., efficacy research), conducted at clinical research centers around the world. This allows us to compare the outcome of our behavioral treatments with results of studies conducted by the experts in the field. Most of these measures are brief and quickly scorable, saving both client and therapist time. In addition, we have both clinical and nonclinical norms available, which allows us to determine the clinical significance of treatment results. Fortunately, practitioners' guides to empirically based measures of anxiety and depression are now available.

Our assessment packet currently contains the following self-report measures: the Fear Questionnaire, Mobility Inventory, Body Sensations Questionnaire, Agoraphobic Cognitions Questionnaire, Anxiety Sensitivity Index, Penn State Worry Questionnaire, State-Trait Anxiety Inventory, and Beck Depression Inventory II. We use additional measures depending on the specific anxiety disorder we want to measure, for example, the YaleBrown Obsessive-Compulsive Scale for OCD.

In addition to self-report measures, we also use self-monitoring measures, such as the Panic Attack Record and Weekly Progress Record, to measure panic attack characteristics and daily mood. As for measures of overt behavior, we use clients' progress on exposure hierarchies and informal behavioral tests when treating specific phobias, such as snake, spider, and bird phobias, as well as claustrophobia. We do not typically use psychophysiological measures.

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