Blank Slate or Tabula Rasa in Therapy

In psychology, the term “blank slate,” or tabula rasa, actually has two meanings:

1. The first refers to a belief that at birth, all humans are born with the ability to become literally anything or anyone. This belief downplays the effects of genetics and biology on the development of the human personality. Instead, we are seen as the product of our upbringing and experiences.
2. The second definition of “blank slate” refers to a technique that was once used heavily in psychoanalysis and is still employed by some therapists today. When using this technique, the therapist is careful to avoid revealing any personal information about himself. Instead, the therapist becomes a “blank slate” onto which the client can project his or her own needs, desires, and beliefs.

Behaviorism believes you are born with your mind as a blank slate and you learn all your behavior from the environment you live in. Therefore, therapy focuses on unlearning unproductive behaviors.

Behaviorists posit any symptoms of a psychological disorder are the result of classical and operant conditioning:

• Classical conditioning is also known as learning by association and causes most phobias.
• Operant conditioning refers to learning by positive or negative reinforcement and, for example, causes eating disorders.

Modes of behavior therapy commonly used to treat phobia include:

• Systematic desensitization
• Aversion therapy
• Flooding
• Exposure therapy and virtual reality exposure therapy
• Behavioral rehearsal
• Skills training

Systematic desensitization is an effective treatment for specific phobia (a fear of a specific object or situation) and social phobia (social anxiety disorder). The theory is the phobia is a learned behavior you imposed on your blank slate. Therefore, you can unlearn your feelings of anxiety.

The therapist helps you learn to relax in what's referred to as your "target situation." After reaching a state of deep relaxation, you vividly imagine your target situation repeatedly. Eventually, you learn not to react, which allows you to feel more comfortable and confident the next time you face your fear.

Aversion therapy is useful in cases where you have an attraction to your bad behavior and despite the pleasure, both you and your therapist acknowledge it's an undesirable trait. You were born with a blank slate but learned a destructive behavior. A good example of this is an alcoholic starting the recovery process.

The therapist helps you associate your undesirable behavior with an extremely unpleasant stimulus. For example, she may ask you to sip an alcoholic drink after you've taken a medication to induce nausea. After vomiting, the hope is the smell of alcohol would trigger your new and unpleasant memory, causing you to skip the alcohol next time.

Proponents of flooding believe in confronting your fears and the goal is to ameliorate your phobia by flooding your environment with the situation or object of your fear. Sort of like teaching someone how to swim by throwing them into the deep end of a pool.

The idea behind this treatment is that fear is a response with limited time and the body will exhaust itself by going through the stages of extreme anxiety. For example, if you are claustrophobic, therapy might involve locking you in a closet for several hours.

Once you calm down you've changed your negative association with your fear into a positive one. Behaviorists also believe flooding prevents avoidance behaviors, which reinforce your maladaptive condition.

Exposure therapy works by exposing yourself to the source of your phobia over time. So if you're afraid of spiders, for example, your therapist might start by showing you a picture of a spider. Later in the process, you might look at a live spider or even hold one. With each step, the "power" of spiders to scare you diminishes until the phobia is gone. A newer form of this is virtual reality exposure, which allows you to accomplish the same goals via virtual reality technology, thereby avoiding the need to, for example, find real spiders. A 2019 review in Frontiers in Psychology found that virtual reality exposure therapy is no less effective than the non-virtual kind and anticipates that with further advances in the technology, it might one day be considered more effective.

For patients who fear situations, rather than things, a therapist might help you imagine a difficult situation, such as a large party, for example, and guides you through the process of facing and successfully dealing with it, step-by-step.

For some people, phobias develop as a result of not having the appropriate skills to handle certain situations. Cognitive behavioral therapy skills training can take the form of direct instruction or role-playing, in which the therapist might pretend to be an interviewer for a job, for example, and you would pretend to be interviewing for the job. The idea is that you'd have learned some skills to implement during a real job interview.