Covert sensitisation and covert conditioning

Domain II · Behavioural & cognitive · Joseph Cautela · 1967 · USA

What it is

Covert conditioning is a family of imagery-based procedures, not a single therapy. Joseph Cautela developed it in the USA from the mid-1960s. Each procedure is the imagined version of an operant procedure: reinforcement, negative reinforcement, extinction, response cost, punishment (covert…

Format

• Phase A: Behavioural analysis and goal setting (sessions 1–2).
• Phase D: In-session conditioning trials.

Who practises it, and how they are trained or regulated

• Phase B: Rationale, consent and imagery training (sessions 1–3).
• Scope and a non-negotiable exclusion. Covert sensitisation and related aversive conditioning were historically used in "conversion therapy" to try to change sexual orientation (clients imagined vomiting or shocks paired with same-sex imagery). That use is ineffective and harmful, and professional bodies condemn it. This guide does not cover, and the procedures must never be applied to, sexual orientation, gender…
• The procedures are usually delivered individually, often as one component in a multi-part programme (skills training, relapse prevention, education).

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• weak middle links; isolate them and train them separately.
• low completion (Section 5.4); rote practice with low clarity.
• whether imagined activities start appearing in the activity log.
• relaxation used as avoidance of the target scene; relaxation-induced anxiety.
• use as a way to suppress obsessional or traumatic intrusions (see 4.13 caution).

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.