“Shrinking” the Gap Between Your Therapist’s Office and the Rest of Your Life: A Look at Behavioral Experiments
“Have you seen ‘Shrinking?’”
It’s a question I’ve been asked a few times since the Apple TV show was released in January. If you’re not familiar, it follows Jason Siegel as a well-intentioned, but often shortsighted, therapist working at a Center for Cognitive Behavioral Therapy, as he attempts to balance his client work and the challenges in his personal life. Without giving too much away, early in the first season Siegel’s character decides to abandon typically-portrayed pillars of therapy (i.e., a passive, non-judgemental clinical style) for a less conventional, more active approach that ranges from yelling at clients about the obvious changes they “should” make in their lives to provoking his clients’ struggles in public spaces.
Recently, when I told a friend that I had watched a few episodes, they followed up by asking, “Do you ever just wish you could do the things he does on the show with your own clients?”
To which I laughed and responded, “Well, a lot of that would constitute some serious ethical violations, but there are a few things in there that I actually have clients do.”
There’s a specific scene in the show’s first episode where Siegel is meeting with a client seeking court-mandated treatment for anger management. The pair leaves the therapy office to sign the client up for training in a mixed martial arts gym. At the end of the session, the client and therapist process whether or not training felt like an effective way for the client to cope with his anger and related impulses.
While it’s unlikely that I will ever drag a client out of my office, mid-session, to blindly try something we haven’t discussed previously, what we see the therapist and client do can be loosely understood as a behavioral experiment, a very real and useful technique in Cognitive Behavioral Therapy (Bennett-Levy et al., 2004).
Traditionally, behavioral experiments are collaboratively designed by the therapist and the client to test and modify beliefs and assumptions that may cause difficulty in the client’s day-to-day life (Beck, 2011). For example, the client from the show described above may believe, “If I do not immediately stand up for myself in situations where I am disrespected, I will feel weak,” serving as a motivation to act on anger-related impulses in self-destructive ways as they arise. In a proper behavioral experiment, after the therapist and client develop skills for emotion regulation in anger-producing scenarios and finding appropriate outlets for coping with anger, the therapist and client may create an experiment in which the client intentionally enters an anger-inducing scenario (e.g., sitting in traffic until someone cuts them off), refrains from acting on anger-related impulses while participating in the scenario, and later engages in a more adaptive coping skill (e.g., participating in intense exercise), while rating their feelings of “weakness/strength” on a 0-10 scale at each step. Then, the client brings the results back to their next session.
This type of experiment can turn up a number of results. For example, the client might find that their feelings of weakness may spike intensely after refraining from impulses that typically relieve anger, suggesting that the client may want to examine how to best cope with or reframe feelings of weakness. On the other hand, the client might find that their feelings of weakness increase only for a short period of time before subsiding or even that the client actually feels stronger after refraining from impulsive behavior and coping with anger in more adaptive ways. Regardless of the experiment’s outcome, the client gets more information about their beliefs and how to handle them, which can be used to create a more adaptive way of living or give more direction in the therapy space.
As is typical of media, the clinical technique (...or lack thereof) in “Shrinking” is radicalized for entertainment value, but, while most ethical therapists will not take it to the extremes seen on the show, therapy can often toe into pretty radical territory for the sake of creating meaningful change in a person’s life. I often tell my clients, “If you see me for about an hour a week, that means there are twenty four hours per day, times seven days per week, minus one where the rest of your life is happening,” meaning the vast majority of the real change is going to take place outside of session. In session, we can review all sorts of highs and lows of the client’s experience, make adjustments to work toward new ways of thinking, get another perspective on ways that the client is stuck in making changes, and even do some in-session experiments, but there are lots of times where the most meaningful step will be leaving the office and putting new skills or changes to work to see how they turn out. For most, these types of changes probably will not require you to step into an octagon to fight another person. That said, if you have been considering making a healthy change in your life, there may be some evidence for “getting into the ring” with that change to see what it teaches you. Even if your problems don’t radically shrink, the way you think about them might change for the better.
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References
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond. Guilford Publications.
Bennett-Levy, J. E., Butler, G. E., Fennell, M. E., Hackman, A. E., Mueller, M. E., & Westbrook, D. E. (2004). Oxford guide to behavioral experiments in cognitive therapy. Oxford University Press.