Chapter 15

Current Concerns and Future Challenges

Are the Behavior Change Goals Acceptable?

answers to the following questions can be useful when evaluating the acceptability of goals:

• is it likely the goal will be met?• will achieving the goal improve adaptive

functioning?• will achieving the goal decrease the likelihood of

physical or psychological harm to the individual or to others?

Are the Behavior Change Goals Acceptable? (continued)

• will achieving the goal decrease problems others have with the behavior?

• will achieving the goal bring behaviors to normal levels?

Dilemmascomplex issues regarding appropriateness of therapy

may create dilemmas that are hard to resolve; for example:

• should psychologists apply treatments designed to make behavior of children congruent with traditionally defined sex roles?

• should psychologists encourage use of diet programs for weight loss when most evidence suggests they do not work?

Dilemmas (continued)

• should therapy programs pursue the goal of reduced oppositional behavior if doing so requires the child spend considerable time alone?

Are the Behavior Change Treatments Acceptable?

• aversive stimuli are used only when other techniques fail and behavior change is considered urgent

• when physically aversive stimuli are used as punishers, the lowest intensity that will produce behavior change should be selected

• appropriateness of use of aversive control should be considered by a professional committee and by the client or his or her guardian

Are the Behavior Change Treatments Acceptable? (continued)• advocacy groups for children have offered

guidelines for the use of aversive control• it is often useful to consider whether or not

behavioral outcomes can justify the use of aversive control procedures

Intrusiveness of Aversive Control Procedures

some institutions do not allow use of aversive procedures when they are intrusive, however:

• no standard criteria define intrusiveness• rigid interpretations may restrict all use of

punishment• limiting use to extreme cases may make

punishment less effective

Rating Treatment Acceptability

• rating scales can be used to evaluate treatment acceptability

• ratings can be influenced by the wording of the questions

• ratings are influenced by the rater’s understanding of the treatment procedure

Ethical and Legal Issues in Therapy and Research

• therapists should be concerned about their ethical conduct

• institutional review boards can evaluate the ethics of treatment

• professional associations can offer guidelines for ethical conduct

General Ethical Principles for Psychologists

the American Psychological Association has developed a comprehensive set of ethical guidelines based on six general principles that require psychologists

• to be competent• to be fair and honest• to consult with colleagues to ensure treatment is

ethical

General Ethical Principles for Psychologists (continued)

• to respect the rights and dignity of others• to have concern for the welfare of others• to exercise professional responsibility to society

Ethical Safeguards in Therapy

the Association for the Advancement of Behavior Therapy suggests the following questions be considered when evaluating the ethics of therapy:

• have goals been adequately evaluated?• has treatment selection been fully explored?• is the client voluntarily participating?• have rights of clients taken precedence?

Ethical Safeguards in Therapy (continued)

• has progress been evaluated?• has confidentiality been maintained?• have appropriate referrals been made?• is the therapist qualified to deal with the problem?

Guidelines for the Application of Behavior Therapy

the American Psychological Association offers the following guidelines for use of behavior therapy:

• client rights should take precedence over rights of those who pay

• problems and goals should be clearly defined• the most effective therapy should be selected for

the particular problem

Guidelines for the Application of Behavior Therapy (continued)

• psychologists should be accountable• the therapist should have appropriate training• accurate records should be kept, and records

should be kept in confidence• use review boards, socially valid treatments, and

informed consent• goals of research should not take precedence over

the rights of clients

Ethical Safeguards in Research

the American Psychological Association provides the following ethical guidelines to protect the rights of research participants:

• rights of participants supersede those of the researcher

• the researcher should describe the nature of the research

• research should not proceed without the informed consent of the participants

Ethical Safeguards in Research (continued)

• the researcher should respect participants’ right to discontinue participation

• research should not harm the participants• deceit should be avoided, but when necessary, the

subject should be debriefed at the conclusion of the study

• the researcher should maintain confidentiality of participants

Ethical Safeguards in Research (continued)

• researchers should correct any unforeseen harm that might come to the participants

Improving the Effectiveness of Behavior Modification

• improve current behavioral and cognitive applications– by improving treatment selection through use

of more thorough functional analyses– by implementing more careful and periodic

staff training procedures

Improving the Effectiveness of Behavior Modification (continued)

• behavioral programs should focus on prevention– by introducing interventions that teach people

to avoid unhealthy activities– by teaching self-management skills that will

allow individuals to head off problems• focus on the prevention of relapse• provide research to show the long-term cost

benefits of behavior modification

Integrating Therapy Approaches

• early behavior modification approaches tended to focus on a single technique

• more recent applications have integrated a variety of treatments

• new therapies including medical approaches must be considered as part of a more comprehensive integrated approach

Enhancing the "Image" of Behavior Modification

• recent efforts have attempted to correct the image problems of the discipline

• misconceptions have been corrected• efforts have been made to show wide acceptance