Story of Psychology - Morton Hunt [383]
In an early form of aversive conditioning used with hospitalized alcoholics, mentioned earlier in this chapter, the patient would take a nausea-producing drug along with an alcoholic drink; the drink was followed by nausea and vomiting. After a number of such experiences, the patient might find the sight or even the thought of a drink repellent.
Later, electric shock became the preferred method for treating motivated alcoholics, heavy smokers, overeaters, persons plagued by obsessive-compulsive routines, and sexual deviants. An example: A thirty-three-year-old man sought treatment for his lifelong interest in women’s undergarments and his impotence with women. He would buy panties or steal them from clotheslines, put them on, and masturbate. In treatment, he would look at a pair of panties or a picture of them or would think of them; as he did so, the therapist would give him a brief but painful shock. After forty-one sessions and 492 shocks over a fourteen-week period, the patient said that panties no longer aroused him; with this obstacle cleared away, he and his therapist were able to treat his impotence by other methods.56
Some therapists used aversive conditioning to treat male homosexuals, delivering a shock to them when they looked at pictures of nude males but not when they looked at pictures of nude females.57 There were reports of modest success with this method, but when homosexuality came to be redefined during the 1970s as a sexual preference rather than a mental disorder, this use of aversive therapy was abandoned.
A mild form of aversive conditioning is called covert sensitization. Patients are trained to punish themselves by thinking some loathsome thought when they are about to do whatever it is they want to stop doing. A drinker, for instance, may be taught that as soon as he walks into a bar to buy a drink, he should visualize himself becoming nauseated, vomiting all over his hands, shirt, and suit, and on the bar and the bartender, but, as soon as he turns away and heads out, feeling better. Evidence of this method’s usefulness has been scanty.
By and large, the stronger aversive methods have fallen into disfavor and now are rarely used. Not only did they involve risks to health, but aroused ethical concerns, patient resistance, and negative public perception of procedures that customarily (and intentionally) cause extremely uncomfortable consequences. These effects often lead to poor compliance with treatment, high dropout rates, potentially hostile and aggressive patients, and public relations problems. Social critics and members of the general public alike often consider this type of treatment punitive and morally objectionable.58 The benefits, moreover, have not proven long-lasting unless alternative ways of behaving replace the inhibited one. For such reasons, most psychotherapists consider aversive therapy a last resort.
Assertiveness training: This is not a single technique but several; all aim to help patients overcome social anxieties and inhibitions and act more assertively in situations in which they have been timid and passive. Treatment begins with education: The therapist and patient discuss threatening situations and identify appropriate responses. The patient is then encouraged to try out those behaviors in mildly threatening situations, and, as he begins to feel some control, extend them to more severe ones.
An important part of assertion training is “behavior rehearsal.” The patient enacts his or her role in a threatening situation, with the therapist playing the part of the threatening person (employer, spouse, neighbor). The patient has the opportunity to practice saying and doing