Implications of object-relations theory for the behavioral treatment of agoraphobia

In this paper I review recent developments in analytic object-relations theory and show how such a frame of reference can formulate and contribute useful clinical insights for the implementation of in-vivo exposure treatment. Since agoraphobic patients tend to relate to significant others, including therapists, in either a safety-producing or potentially anxiety-provoking fashion, knowledge of developmental object-relations theory can aid the behavior therapist in avoiding the enactment of one or the other side of the split. In-vivo exposure, is structured to guard against such enactments. However, the therapeutic relationship often becomes stormy and current social learning theory has provided few guides in managing the therapeutic relationship.