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Patients Attitudes Toward Behavior Therapy and Psychotherapy

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Patients
BY R. BRUCE AND ALLAN

Attitudes
SLOANE, H. CRISTOL,

Toward
M.D., M.D. FRED

Behavior
R. STAPLES,

Therapy
PH.D., KATHERINE

and Psychotherapy
WHIPPLE, M.A.,

A questionnaire behavior psychotherapy those value patients on insight, and trust. therapy than therapy

survey

of5O

patients

treated

by oriented as well as

cerned that such The

their treated

with their relationship treatment interpersonal present

therapists by

with their therapist techniques. factors These played the attitudes

process and those treated

than authors felt

or short-term, revealed who improved that both

analytically groups,

with specific role in the outcome

an important toward
of patients by

the most,

placed relationship,

a high

of treatment. paper
and behavior

the patient-therapist The findings patients do their therapists been thought important tend

compares
the treatment therapy

catharsis, behavior emphasis traditionally psychotherapy.

suggest to place

that more that have

on factors in analytic

short-term,

analytically

oriented

psychotherapy.

METHOD

Data
CONSISTENT WITH

for this study outcome that (6). To describe assigned to study

were

collected of behavior is reported

as part of a comtherapy in detail briefly, 94 patients and psyelse-

their behavior

belief

that

the proper of the application the experimental placed major

treat-

parative chotherapy; where

ment

of abnormal

consists derived from have

study

of principles laboratory,

of learning behavior

the

study

therapists

em-

were

1 of 3 groups-psychotherapy

phasis
such tioning, ables tion involved patients. that well. Frank tance

on the therapeutic
as desensitization, and the like. Cognitive have received in a close, In such potentially

use of specific
aversion, operant and interpersonal comparatively behavior helping relationship it would factors

techniques
condivariattenbecome with be expected operate as their

(N=30), (N=34). at the Temple

were

behavior The patients,

therapy University
good

(N=30), Hospital

or a waiting for treatment Outpatient

for individual intelligent, beyond diagnoses and problems. of both and gains had

list Clinic,
therawell high of signifiAt the

who had applied

candidates were had

little therapists

considered criteria. (average for the

(1, 2). Nevertheless,

py by most educated school), neurosis cant

They of 2 years most part

young, of education received

an atmosphere therapeutic

other

or pathological but not entirely

personality, incapacitating

(3) and others of such nonspecific model

(4) have factors

emphasized as the provision

the imporof a and

end therapy

of 4 months and

treatment, psychotherapy list showed

80% patients sufficient

the behavior

50% of those
to be consid-

theoretical how patient s to relieve

to explain it; an emotionally

the patient s charged, information of the expectation

distress

on the waiting ered improved 60 patients seen

confiding about of help; the

or symptomatically in the therapists 2 active in each The therapists of experience. than 20 years

recovered. treatment group, in each One therapist experience, groups i.e., each group in one

relationship;

provision problem; arousal

of new

The were

by 1 of3 saw

provision
emotional and ence, should and patients other

of success
arousal. techniques are ( 5) which be present The

experiences;
opportunity such emphasized in behavior interviewed and as catharsis

and facilitation
for these and as well. in analytic therapy 14 behavior found them more factors transfertherapy, Ryan therapy

of

therapist were each

10 patients. in terms had more

matched group

had 10-15 experience. analysts, a training using analytic

years

experience,

and one had 6-8 years were psychoanalysis experience based were on the for free to use techniques therapists with in

Two of the psychotherapists while the third was in personal analyst. All had considerable treatment Behavior they

Gizynski after

treatment

con-

short-term model. techniques

Presented

at the

129th

annual

meeting

of the American

Psychiatric

whichever

felt most appropriate

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Association, Dr. Sloane fessor, chiatry, Angeles. try, Temple to Dr. Sloane fornia 90033. and Miami is Professor Ms. Whipple Dr. Cristol University, at Los Angeles University Beach, Fla., and Chairman, is Research of Southern is Assistant Philadelphia, 1934 Hospital

Patients Attitudes Toward Behavior Therapy and Psychotherapy

May 10-14, Dr. Staples Assistant, California Professor, County-University Place, Los School Department Pa. Address reprint of Southern Angeles, 1976. is Associate Department of Medicine, of Psychiarequests CaliCalif. Proof PsyLos

the individual cific technique,

training, presented. One year because

patient. such
of the

They

were not limited

of patient

to a speor assertive
problems

as desensitization
variety

after

beginning

treatment,

the

patients

Medical

Center,

were pressions

mailed

a questionnaire of the treatment.

that asked Of the 60 treated

for their impatients,

134

Am J Psychiatry

134:2, February

1977

Page 2
SLOANE, STAPLES, WHIPPLE, ET AL

50 (half from

the behavior group)

There those who

therapy
were failed

group

and half from and returned

differand those

ation training,
ment These

training, setting
process differences

systematic specific
were very

desensitization, goals, and explaining

important with to their the specific

assertive the treattreatment. tech-

the psychotherapy
their ences who The questionnaires. between did.
first

completed
to respond

no apparent

are consistent

niques section questions

parts helpful,

used
items

in each therapy.
reflecting specific techniques were con-

of the
of treatment what

questionnaire the patients

were helpful, they

contained to comwhich had held

Many

open-ended
ment were on which not

that allowed
expectations

sidered
in each

very
group. that but also with every

important
This they were may

by only a minority
be due a less not only significant part

of patients
to a general of treatwas of the train-

feeling ment used

about treatment,
were not met.

and how section characteristic training of your They of therapy also included of psychotherapy

these the patients of behavior

expectations rated therapy (e.g.,

were or the impor(for exto those events in of was rated very imor not patients

to the fact that not every patient. patients For example, considered

technique only 52%

In the second tance of 32 factors from ample, characteristic the relationship your life). both forms and manner on a 5-point portant, important). The last section an opportunity during treatment. those by

behavior

therapy

assertive

to their treatment. in muscle problem (for example, Each

The items ranged relaxation) to early items characteristic the appearance item important,

ing (item
four percent

16) extremely
considered

or very
it slightly

important.
or not important;

Twentyit

may well be that many of these patients

assertive training.

did not receive

by explaining

Most Many

Versus

Least

Successful considered therapy a more who

Patients most pleasant important experience. auun-

of the factors make

of your therapist). scale ( extremely important, slightly of the questionnaire to comment

doubtedly A professional

person

provides

a sympathetic

important, offered

dience
the nature

and helps

in achieving
may

some
appear

understanding
very important

of

of the problem

to the suffering these showed whose factors marked treatment

provement

patient
is shown.

with a bruised
The opinions

ego. However, imof those who

on what they had learned

may have little to do with how much improvement was less successful we considered
the most successful therapy, were beginning patients

in therapy

and of those

may be more releseparately

and least and again

RESULTS

AND

DISCUSSION

vant. Consequently,
ceptions of

General Table

Findings 1 shows the percentage of behavior therapy

the persuccessful after inter4

patients.

Before treatment,

and psychotherapy
extremely important

patients each as slightly The items are presented to psychotherapy

who

rated

each

item
and

as
of

months

extensively

or very

important

viewed severity specific most. patients reduction

(average considerable
(assessor

by an experienced of their general target In the were defined in the severity

of more
rating

psychiatrist maladjustment that bothered analysis as those most who showed

on a 5-point overall better).

who rated and of the 3 them successful a marked symptoms

scale) functioning Twelve

the the

those

who rated

important in rank order patients.

these data

or not of

important. importance
What is most

symptoms present

striking

about

are the simi-

larities py patients
Both

between
groups

the behavior (rank-order

emphasized the

therapy correlation
same

and psychotherap=.8O,
factors

of their 3 target
2 points in their least much

p<.OO1).
as being

than improvement
ofat

and

most important endorsed tionally apy. These tion of the patients tionship; confidence.
sonality of y our

in their items largely

treatment. refer to factors important insight,

The most frequently that have tradiin analytic psychotheran explanarelaof to

to an

be-

havior
criteria.

therapy
2 shows

and 9 psychotherapy
the factors considered

patients

met these
extremely or

been thought include catharsis; A behavior

doctor

or providing the patient-therapist and

Table

problem; trust; therapist consider

and

very important cessful those sight, considered there thought patients. rated catharsis, central

by at least two-thirds In general, most important and the therapists by patients similarity patients. only important these factors

of the most sucare similar personality in both groups. between Factors were Again, the behavcommonly to Inby the total sample.

development might be surprised

learn that his patients

understanding chotherapist person might

such items as the perbeing able to talk

so important.

Similarly, at the inclusion

a psyof by

was considerable to be characteristic

be surprised

ioral and psychotherapy were also considered

encouraging
that bother

you gradually
you.

to practice

facing

the things

of psychotherapy

by at least half of the

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There behavior
psychotherapy the relationship

Patients Attitudes Toward Behavior Therapy and Psychotherapy

were few significant therapy and
patients of your

differences psychotherapy
felt the problem item to early

between groups.
by events

the More
in

most successful tors were very

behavior important

therapy to a higher

patients. These proportion

facof the

explaining

most groups important

successful as a whole. group, by 67%

patients where to 89%

than

to the evident

treatment for the successful

1977

This is particularly the 9 factors of the most

134:2, February

your life was extremely havior therapy patients

or very important. felt that items involving

More berelax-

psychotherapy

considered

Am J Psychiatry

135

Page 3
ATTITUDES TOWARD BEHAVIOR THERAPY AND PSYCHOTHERAPY

TABLE

1 of 32 Factors by Patients Receiving Psychotherapy (N =25) and Behavior Therapy (N =25), in Percents

Rating of the Importance

Extremely
Important

or Very

Slightly
Not Important

or

Psy choFactor therapy

Behavior Therapy

Psy chotherapy

Behavior Therapy

ChiSquare

3. His helping 1. The personality 6. By encouraging

y ou to understand of y our doctor y ou gradually

y our problems

76 68

88 72

12 12

8 8

1.0798 0.0950

to practice

facing the 64 60 71 54 20 24 21 25 0.2598 0.1700

things that bother y ou 5. By helping 9. Encouraging responsibilities 12. The skill ofy ourtherapist 11. By helping
29. Giving a direct

y ou relax y ou to shoulder by restoring y our own confidence in y ourself

60 60

58 52 64
72

24 24 20
33

8 28 12
20

0.0 139 0.3246 0.3332

1.6753

y ou to understand
answer when

y ourself
you asked a question

56
54

7. Being able to talk to an understanding

person improve
even ifit was unpleasant to treatment of your problem to

52 50
48 48

75 56
48 44

32 38
36 32

21 28
28 36

2.787 1 0.1767
0 0.0804

27. His confidence

18. By helping 20. Changes 4. By explaining early events

y ou would
you face reality in your life not related the relationship in yourlife and manner advice

48 ofyour therapist 44 36

21 33 56

36 28 40

63 25 12

3.9884* 0.5866 2.0126

2. The appearance 23. The practical 25.

ofyourdoctor

Showing
yourself

y ou why y ou were reluctant

to talk or help
36 44 48 40 0.3332

31. The way he dealt with y our doubts

22. By showing pleasure when you made

about treatment
progress

33
32 32

36
40 32

54
56 36

40
36 48

0.0383
0.3472 0

10. By just
17. By following

plain liking y ou
the doctors suggestions ofthings to do

between
2 1.

interviews y ou to try to react in a more mature

28

44

52

32

1.3888

By expecting
way

28

36

44

32

0.3676

16. By encouraging
28. Setting 13. By practicing goals

y ou to speak
for you to reach with the therapist

up for y ourself

24
21

52
48

56
58

24
36

4.1594*
3.9884*

behavior

that had

been difficult for y ou

24. Discussing therapist your himself personal feelings toward the

20

40

72

44

2.3808

20

36

64

52

1.5872

30. His explanation

26. Showing 8. By helping

ofhow
you the meaning you to understand

the treatment
ofyour

works
dreams other

17
17

44
8

63
75

40
84

4.3066*
0.8557

that many

people
15. By training things

have similar problems

you to stay which used to make relaxed as you imagine doing

16

33

60

58

1.9890

you anxious

32

84

36

4.5000*

19. The medicine

32. His efforts

y ou were taking
to influence other people

8
8

12
12

80
79 100

76
80 64

0.2222
0.1794 55554**

14. By traininginmusclerelaxation
*

20

p<.O5.

* * p < O l

patients
Five

were
patients

considered
in each

important
of the 2 groups

by only
showed

50%

to
only

The

less successful pattern.

psychotherapy The a direct only factor answer

patients that 4 of the when

showed
5

76% of the total group.

no consistent agreed

on was giving

you asked

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minimal
than and 1-point

Patients Attitudes Toward Behavior Therapy and Psychotherapy

improvement,
rated improvement no higher

i.e., they
than

on their

averaged
3 target

symptoms improved

no more
in

a question. presented
portant

However, an interesting
factors was virtually

the behavior picture.

Their

therapy patients list of most im-

were

slightly

identical
patients

with that of the

(see table 2).

their overall

adjustment.

most

successful

psychotherapy

I 36

Am J Psychiatry

134:2, February

1977

Page 4
SLOANE, STAPLES, WHIPPLE, ET AL

TABLE

2 Extremely or Very Important by Two-Thirds of the

might have been, they all showed tive improvement cessful that these
PsychoBehavior

considerable in the more only conjecture, although attended found

objecsucwith

Factors Considered

Most Successful Patients, in Percents

and were included It is possible, would therapists the patients

group.

patients had their which

have felt more satisfied more so vital.

treatment relationship,

to the

therapy
Factor (N=9)

Therapy
(N=12)

Common

to both

therapies

1. The personality 3. His helping y our problems

6. By encouraging practice 12. The 7. Being facing skill of your able to talk

of y our doctor y ou to understand

89

67

CONCLUSIONS

89
you things therapist to an person of psychotherapy you you you relax to understand to shoulder by restoring 75 would therapy of your improve only doctor 44 67 yourself your only 78 78 67 gradually that bother to you 78 78

83

1. The patients py. They tended their therapists that was formed.

behavior reacted similarly

therapy

and

psychotherapy in theraqualities alliance groups the in

to their experience of therapeutic that both important by Frank endorsed model of insights However, treatment

67 67

to value the same personal and the type of the factors considered factors outlined you to understand most frequently of explanatory and the kind quite different. purpose that behavior therapists. cases

understanding Characteristic

75

2. Many most frequently nonspecific ample,

resemble (3). For exyour problems by both provided achieved

5. By helping
II. By helping

58 64

helping

9. Encouraging own responsibilities

confidence 27. His confidence Characteristic 23. The practical

in yourself you of behavior advice

58 50

was the item groups. The type each type of therapy were served patient. 3. It would place much ship than undoubtedly

by

both

67

the same therapeutic appear more emphasis do their feel that in many (6). Such attitudes therapy sometimes literature, diminish

in the eyes of the therapy patients relationoriented

is

on the therapeutic Analytically the relationship are rarely and behavior or underutilize operating,

These and gaining ented

items

reflect trust, confidence,

such

traditional rather than

variables with the therapist, behaviorally techniques may have been patients.

as inonOne such

therapists the treatment behavior may

sight, catharsis, factors.

relationship

cited in the therapists a powerful

The reasons is that specific or assertive with the less successful did receive aspects the less successful stated their treatment, a panacea, make the less

for this are not clear. behavioral training

possibility
as desensitization

force that is nevertheless in their treatment.

unacknowledged,

ineffective efit these patients nonbehavioral In addition, patients cures attitudes, By contrast, patients A few proach these mechanistic patients py. All ofthem from lous cure,

What bento the

REFERENCES

might be attributed behavior expectations from

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social of Wolpes

and

cognitive procedure.

factors Psychol

underBull

that they had expected for example, a complete successful more what to expect had expected approach.

7 6 : 3 1 1 3 1 7 ,

Spanos therapy :
1973

NP, Dc Moor W, Barber common

JD: Therapeutic 1 9 7 1

TX: Hy pnosis Am J Clin

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denominators.
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16:45-64,
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3. Frank

in psychotherapy.

t h e r2 5 : 3 5 0 3 6 1 ,

either patients expressed

expressed who behavioral felt that therapy

4. Strupp

H: On the basic ingredients 41:1-8,

Psychol

of psy chotherapy . therapy in retrospect.

J Consult J ConVerPress,

goals or did not know

Clin Psy chol 5. Ry an VL, Gizy nski

sult Clin

1973 MN: Behavior

37:1-9, 1971

disappointment

6. Sloane RB, Staples FR, Cristol AH, et al: Psy chotherapy sus Behavior Therapy . Cambridge, Harvard University
1975

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Patients Attitudes Toward Behavior Therapy and Psychotherapy

Am J Psychiatry

134:2, February

1977

137

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