Reconceptualising Exposure and Some Implications for Cognitive-Behavioural and Psychodynamic Practice

Abstract

The concept of exposure is ubiquitous in the research and practice of clinical psychology, most notably in cognitive-behavioural models. Yet there remains confusion and ambiguity around how exposure in ‘exposure therapy’ is characterised. Current definitions are found to be inadequate, as each identifies certain features of the exposure process but omits others. As such, an elaborated model of exposure is presented, referred to here as the re-exposure-extinction learning process. This process involves a complex causal situation consisting of clinical features (the cause/causes, C), acting upon a person (the field, F), to bring about re-exposure to anxiety-provoking stimuli and then extinction learning, leading, over time, to therapeutic change (the effect/effects, E). Importantly, re-exposure and extinction learning are two processes distinct from the therapeutic procedures (i.e., techniques and methods) used to bring them about. Furthermore, these processes are not inherently tied to a particular model of therapy or clinical intervention. They are, therefore, logically independent of the procedures used to facilitate them. Considering this reconceptualisation, we propose that working in the transference, a cornerstone of psychodynamic psychotherapy, can be understood as a complementary and effective method of facilitating the re-exposure-extinction learning process. We argue that this is achieved through enabling a person to repeatedly re-evaluate their fearful expectations as they manifest in the unfolding dynamics of the therapeutic relationship. Finally, some clinical implications indicated by this elaborated model are explored.