Understanding Abnormal Behavior - Cengage Learning

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The Case of Steven V. xxv
tried to make her prove she “cared for him.” He had accused her of not being faithful to him, of not
caring for him, and of not including him in her extracurricular school activities. This continual “prove
you love me” testing of their relationship never ended because no amount of reassurance seemed to be
enough. In fact, it pushed Linda away from him.
This mode of interaction was characteristic of nearly all Steve’s relationships. While he worked to
combat this irrational belief (“I am worthless; therefore no one can like me”), I felt it was important to
help Steve become more comfortable in interpersonal and heterosexual relationships. I attempted to
help Steve subtract anxiety from his interpersonal encounters by using a behavioral technique:
assertiveness training.
Here is Steve talking to me again:
The truth is I’m always afraid. I panic when I think about being in a group of people and having to
talk to them. What am I going to say? Even if I could say something, who would listen? Last
month I went to a party with Linda—it was thrown by her friends. —When she introduced me all
I could say was “hi.” I stuttered when I said anything else. It was like in class—I really felt
inadequate. And one of the guys was trying to hustle Linda. He knew Linda came with me, but he
ignored me completely. He asked her to dance, and I spent the whole evening sitting in the corner.
I was really angry at him and Linda too, but I couldn’t do anything about it. Then he came over
and asked if I would mind if he took her home. I could only say, “Sure, go ahead.” When I really
wanted to say was “Go to hell.” I feel like I’m a doormat for the world.
Obviously we had to work on Steve’s assertive behaviors. What I intended to do was, briefly, the
following:
1. Identify Steve’s unassertive behaviors that were linked to specific situations (for example,
withdrawing and sitting in a corner by himself and not being able to say no).
2. Determine the specific skills he needed for assertion (saying no, introducing himself to strangers,
asking Linda to dance, and so on). Then try to grade these skills from least to most assertive.
3. Re-create the problem situations, as vividly as possible, in the consultation room. Engage Steve in
role playing and behavioral rehearsal with me or volunteers.
4. Get Steve to practice the assertive behaviors in actual situations, under my guidance and
monitoring.
Our first use of the procedure will illustrate how we implemented it. Steve and I identified an upcoming
event that was causing him considerable apprehension—a class assignment. He was to give an oral
critical analysis of an assigned novel in his English class and then lead a discussion of the novel.
Steve needed to practice the assertive skills related to the oral presentation. First to desensitize him, I
had him practice very low-level assertive skills in front of groups. For example, he practiced raising his
hand in class in situations where he was sure he would not be called on—for example, when many other
students raised their hands or while he was out of sight of the professor. To Steve, this act was an
assertive one. After he became comfortable with that, I asked him to raise his hand and ask a simple
question (a safe assertive skill), such as “Could you repeat that last point?” After his anxiety regarding
this act was conquered, he proceeded to paraphrase what the instructor had said and finally to state an
opinion. Each succeeding act represented an increase in assertiveness.
While he was practicing these classroom acts, Steve was finishing his book report. I then asked him to
do his oral report for me. Next I asked another counselor and the two clerical staff members to be
present while he repeated the report. After a second repetition, we simulated a question-and-answer
session and then repeated that several times.