Method of Treatment

The Purpose of the Initial Interview

When a client comes in with psychological distress or physical symptoms that have no medical cause, the therapist’s first task is not to label the problem but to understand it. This is done through a detailed interview aimed at analysing the client’s behaviour patterns. The goal is to figure out what is going wrong, why it started, and what keeps it going.

The Three Pillars of Behavioural Analysis

Behavioural analysis breaks the problem into three distinct parts:

• Malfunctioning behaviours – These are the behaviours that actually cause the client distress. They are the target of treatment. For example, smoking is a malfunctioning behaviour if the person wants to quit but cannot.
• Antecedent factors – These are the causes or triggers that originally led the person to develop the faulty behaviour. They are the “why it started” part of the story.
• Maintaining factors – These are the conditions that keep the faulty behaviour alive even after it has become harmful. They explain why the behaviour persists.

A Concrete Example: Smoking

Consider a young person who has picked up smoking and now wants to stop. Through interviews with the client and family members, the therapist discovers that the person started smoking while preparing for annual exams. The exam preparation was an anxiety-provoking situation. Smoking gave immediate relief from that anxiety.

Here, the anxiety-provoking situation (exams) is the antecedent factor – it caused the behaviour to begin. The feeling of relief after smoking is the maintaining factor – it reinforces the behaviour and makes the person want to repeat it. The client has learned an operant response: smoking is maintained because it is reinforced by anxiety relief.

The Treatment Package

Once the faulty behaviours are clearly identified, the therapist selects a treatment package. The aim is straightforward: extinguish or eliminate the faulty behaviours and replace them with adaptive behaviour patterns. This is not about simply stopping the bad behaviour; it is about teaching a better one.

Antecedent and Consequent Operations

The therapist achieves this by using two kinds of operations:

• Antecedent operations – These control behaviour by changing something that happens before the behaviour. One powerful type is the establishing operation, which increases or decreases the reinforcing value of a particular consequence. For instance, if a child refuses to eat dinner, an establishing operation would be to reduce the quantity of food served at tea time. This makes the child hungrier at dinner, thereby increasing the reinforcing value of food at dinner. …