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Verbal Punishment in Behavioural Therapy. What does the Therapist Punish?

Table 1: Client’s punished behaviors grouped into categories.

CATEGORY AND DEFINITION EXAMPLES
Anti-therapeutic verbalization (content) Those client’s verbalizations expressing interpretations, ideas or beliefs against the therapy goals (both general and specific) and complicating its progress. - Distorted interpretations of reality, either referred to oneself, to others or to the situation. Example: “It’s just that if I start to eat those things I will lose control and I’ll become as fat as a pig.”- Negative anticipation, either of their own behavior in a future situation or in a future situation in itself. Example: “I know that when I get the meeting I won’t be able to say anything.”- Lack of confidence in the therapy, either referred to the therapist as a professional, to themselves as a client or to the therapeutic process in itself. Example: “That is something that I won't achieve, not even in a hundred years of therapy.”
Anti-therapeutic verbalization (form) Those client’s verbalizations complicating or making difficult the therapy progress because of how or when they are produced and independently of what its concrete content is. - Not to answer to what the therapist is asking or not to do it properly. Example: - Therapist: “What do you think that you could have done to avoid the argument?” - Client: “Juan must have cleared the table and that’s all!” - Not to allow the therapist to speak, or to interrupt the therapist while speaking.
Example: - Therapist: “It’s important that…” - Client [Interrupting]: “But it’s just that in that moment I don’t think about it and, you know, I get swept up and I explode.” - To go off topic, to get off track. Example: - Therapist: “Last week we agreed that the days you went to the gym you would not train for more than half an hour.” - Client: “Yeah, well, it’s just that I start my exams very soon and they’re in a row. In addition, I have to hand in a paper and…” - To discuss or to reject what the therapist says, to be opposed to their reasons, contradict themselves. Example: - Therapist: “You will probably perceive a positive change in him/her too if you start to change some attitudes and comments.” - Client: "No, not at all. I’m the boss and that would mean showing myself weak. They would lose respect for me and would laze around.” - Not to change a topic, keep talking about something in spite of the therapist's efforts to settle the topic or to go to another matter. Example: - Therapist: “Well, let’s put the birthday matter off, we still have a long time. Now, tell me, how are your exams being? Can you control your anxiety?” - Client: “But it’s just that if he/she celebrates it with a party or something I will be overwhelmed. And I want to go, but I know I will be overwhelmed.”
Speech Client’s verbal behavior, regardless of its content or form, when the therapist wants to stress or to call the client’s attention to something important. - The client mentions something that the therapist considers important and this one interrupts to stress it. Example: - Client: “He sees it and you do perceive certain change, don’t you? Like he is more comfortable and...” - Therapist: “Sure, sure. Check, all the work we are doing is bearing fruit and it is reflected in the fact that you are better and he is also.” - The client speaks about any old topic and the therapist interrupts to stress something important related to that topic. Example: - Client: “I’m already nervous when I get the exam, but if I find anything that I don’t know or I doubt, I just get carried away and I can’t…” - Therapist: “Well, look. Because of that it is important for
you to practice relaxation every day and get to control it.” - The client speaks about any old topic and the therapist interrupts to stress something important related to that topic. Example: - Client: “When I was doing what you told me about writing down my thoughts…” - Therapist: “Wait a minute. Before you continue. Did you get rid of the scale as I requested?”
Anti-therapeutic behavior Those client’s actions complicating or making difficult the therapy progress and cannot be considered as antitherapeutic verbalizations. It is included within this group both the behaviors happening directly in session and the client’s verbal report about them in case of happening out of session. - Not to follow the therapist’s instructions or not to do the assigned tasks, either in or out of session. Example: - Therapist: “Last week we agreed that you would not work on Sunday at all and you would spend your day with Elena and the children, didn’t we? So, what about it?” - Client: “It’s just, you know, my boss called me to give a service and I was busy on Sunday morning, so finally Elena and the children went to her parent’s country house and I stayed in Madrid.” - To carry out inappropriate, disruptive or opposed to the therapy goals behaviors, either in or out of session. Example: - Therapist: “If you want to continue I need you to sit and calm down” - Client: “It’s just I don’t want to sit nor calm down!”
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