therapy

Interpretation in Therapy

/ Chris Sawyer, M.Ed.,BCBA / Leave a comment

Imagine for a moment, the process of therapy. It is a give and take where the participant wants change to occur, both in themselves, and in how they interact in the world. Something in the past has not gone as right as they’d like, and this process is meant to help them explore a better path ahead. Imagine also the clinician is in the room with them, listening intently as they speak about their experiences and works on the formulation of hypotheses to explain the client’s behavior both in and outside of therapy. In the therapy setting, even listening to these stories and relations of what happened in the past, the clinician is still limited in their full understanding of the information and experience. They do not have enough information, even from detailed stories, to come to a full conclusion.

In an experimental setting, a behavior analyst might find ways to mimic the natural environment, and contrive similar situations and stimuli for the client to engage with in order to get more information. They may try to manipulate the environment as best they could to see how the client responds to simulated contingencies. It could be roleplay. Something close to the original but not exactly that, something controlled with just enough of the original event to elicit similar behavior. It might even come close, and shed more details on what factors maintain certain behavior patterns. Progress. You would not want exposure to something that was expressed in confidence and trust, especially something fearful or aversive, to be presented without preparation or complete consent. It would be carefully chosen, described, and all features of the design and presentation would be agreed on. Progress would grow from mutually prepared steps.

But there is also a part that is somewhat subjective on the part of the clinician. Even if they did a great deal of functional analytic work on both indirect assessments, through interview, and direct assessments, with an experimental scenario, an interpretation is necessary. In fact, it’s owed to the client. They want to have an explanatory system for what is going on, and what can be done to make things better. It needs to tie in and make sense with what they have told, and the experiences they related. It is the duty of the clinician to be as careful as possible with the information they have received, and made the best hypotheses, not out of thin air, but from research and the functional and relational frameworks that could be understood from it.

Interpretation has been around a very long time in psychology. From the old Freudian psychoanalytic methods, interpretation was a great deal of the process. A story, or memory, or dream would be related to the psychoanalyst, and from that there would be an interpretation based on what the analyst saw in the subconscious of that individual. Sometimes it was helpful. Sometimes it was not. Since then, the field has been split on those specific methods of interpretation. In behavior analysis, those intuitive leaps have largely been set aside for more concrete environmental events and not hypothetical subconscious features. A person’s environment, including all the people and experiences they have been affected by, are what behavior analysis largely deals in. There is a focus on the outer world, the experiences that shaped an individual, that is said to have more scientific bearing than trying to guess at a hypothetical construct of subconscious from another person.

In behavior analysis, we prefer to look at the longer behavioral patterns as having more predictability to them. When we see a long term pattern of behavior, it makes the process of contriving changes in the person’s environment more straight forward. We can introduce a new variable and see the change. If a person’s behavior is erratic over a long period, with a great deal of variability, it makes it all the more challenging to know what new change has any effect, if at all. Stable behavioral traits, and patterns, give something to base interpretation of results off of. It’s a baseline. Using a baseline is also helpful in interpretations as well. Think of it as the start of a story. The baseline is the opening of the therapeutic story. Imagine a 10 chapter story. This is chapter 1.

Next comes the data. In behavior analysis, it is the measurable and observable which is trusted most, but even someone relating a story of a past experience can be measured and observed when we make the features of that related information salient enough to test. If someone says they have trouble ditching cigarettes, we could ask how many they have a day, determine a baseline rate, and go from there. Changing variables onward, based on that daily average, can give us information which is observable and measurable (fewer cigarettes smoked). Stepping away from that example, let’s imagine the behavior is more anxiety based, perhaps avoidance of certain situations, people, or information. While we probe on past experiences we may learn something to base our treatment on. Also, during this period of probing and hypothesizing, there may be more uncovered. Information that was not salient before might pop up in the information related by the client.

In certain psychological traditions, this is the end. Catharsis is what it was called. Information that was deeply buried, eliciting a strong emotional response in therapy, was seen as curative in itself (that will be another topic in the next post). To many, it does feel that way. It feels like a relief. In behavior analysis, however, we try to take it a step further. The uncovering of a past trigger, or antecedent, is valuable. Absolutely. But then we ask, does that change the behavior we are targeting now? Does that expression in therapy, by itself, make the avoidance diminish? It may, but in many cases, it takes the behavior of the client afterwards to make lasting change and growth. But, we have causal information. Our hypothesis is stronger. We can use that in our framework for behavioral change and success. That is the next step in the therapeutic interpretation, the story, and let’s call that chapter’s 2-5. We have now determined a pattern, and have started an intervention to it.

Next, comes analysis. Imagine over the course of the following weeks we see a broader lasting change. Let’s say that when the new therapeutic change was put in place, and the behavior we wanted to see drop actually dropped in the long term, we can assume there is a degree of control there. The therapeutic technique seems to work. Now, we can’t say it works for everyone. We can’t say it works all the time. We can’t even say that if a bad day hits with all the old triggers for the maladaptive behavior, that it would not return. What we can interpret and say is that, given the situations we have tried here, we have a level of control that can be seen, and hopefully, the client has been happy with. It delivers the wind down of the process, which may lead to even more changes and tweaks along the way. There may be several more adjustments, different treatment options, different environmental changes that stem from. Let’s call this chapter 6-7. The story is not over.

Our interpretation here is verbal. It is a narrative, a story, an explanation of complex behavioral, neurological, and environmental change that is summed up in a way that makes sense to us. The analyst and the client can agree on what the important factors are, and the change is spoken of in a way that the client can understand. If the clinician values the use of an interpretation, they won’t over use scientific jargon if it’s unnecessary. A word like reinforcement might be key, but it would be used for the purpose of relating a specific useful piece of information within the interpretation. The interpretation isn’t magical either. It doesn’t solve the situation in itself. It is chapters 8-9. It gives an account of a behavioral pattern that has been explored, and changed, but without the false promise of that change lasting forever. When it is related to the client, they may understand how their past experiences, their environment and reinforcement or punishment history affected them, and with the intervention, changed in a better direction. The interpretation can be valuable to them to that degree. It codifies a type of behavioral transformation, a change, a growth, a learning experience. But we have to be very clear that this interpretation is not final, or complete. When looking at the lifespan of an individual, behavior is what they do from the start of life to the very end.

Chapter 10 doesn’t come until the end of a lifetime. There is no way to conceptualize the finality of a person’s behavior without the whole story. This is largely outside the scope of therapeutic interpretation, but is important to it. It is always ahead, which means that the therapeutic interpretation maybe complete in the short term, but will necessarily never be in the long.

Thoughts? Questions? Comments? Leave them below.

References:

Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied Behavior Analysis. Pearson Education Limited.

Dougher, M. J. (2000). Clinical behavior analysis. Context Press.

Madden, G. J., & Dube, W. V. (2013). Apa Handbook of Behavior Analysis. American Psychological Association.

Image Credits: pexels.com

Getting Back Up After Failure

/ Chris Sawyer, M.Ed.,BCBA / Leave a comment

Failure is a tough topic to bring up but a necessary one. When we are in it, it’s all we can think about. When we are past it, we often do not want any further reminders of it. Failure, behaviorally, and psychologically, is a part of everything we do as a variable, and factors in to every future strategy we use. It is a part of our past that defines how we interact with the future. In a previous writing I discussed “Overcoming the Fear of Failure”, but this one will be about what to do when it happens to us. How do we move on? How do we grow from it? How to we set our future expectancies to do better? To what do we attribute failure to? All of these and more are necessary to making each failure a stepping stone to a future success, or else we might find ourselves in a loop generating ever worse strategies. Instead, we need to learn to get back up. Let’s talk now about some of the research we have on the topic and how we might navigate failure and find motivation from it.

Mastery Orientation vs. Learned Helplessness

When it comes to deriving motivation from failures, both big and small, the strategies that we develop in childhood have a great deal of influence on our current behavior. You may have heard of the term “learned helplessness” before, which describes a pattern of behavior of low motivation and outputs after repeated failures. The individual receives so little reinforcement following their actions that they simply do not continue to try. Diener and Dweck (1978) popularized these concepts in a study on youths that they split into two groups based on patterns and strategies that they observed without being taught. They found that some children when faced with repeated challenges and varying degrees of failure would either consistently give up, and reduce responding, while others would re-assess and modify their responding based on the inputs of their failure. The researchers were very interested in the cognitive strategies that both of these groups displayed, all without any coaching, and determined that even at a very young age, there were clear distinctions on these two types by their ideas on their loci of control. A locus of control is a belief system that people use to determine whether they have control of outcomes, or if outside forces do. A person with an internal locus of control would see the results of their actions as largely based on their own actions and future control. An individual with an external locus of control would see the results of their actions as largely impacted by an outside force or their environment. Now, there is a part of this study that some consider a little unfair. No matter what answer the children gave to their respective stimuli at the start, they were told they were incorrect. How they responded afterwards largely correlated based on how they viewed their loci of control.

Mastery oriented individuals appeared to generally attribute their failures to a lack of effort or something they’d missed. Even at that age, their first reaction focused on pivoting and reassessing.

Learned helpless individuals tended to attribute the failures to the situation as largely beyond their control (in this case, without knowing it, they were technically right as far as the experiment was concerned).

So what happened?

Mastery oriented individuals kept trying, kept changing their responses based on feedback, and largely kept at the task longer than the other individuals. They showed no decline and became more sophisticated in their strategy use (which was eventually validated).

Learned helpless individuals tended to show a progressive decline in the use of good-problem solving strategies and began to include less sophisticated and poorer problem solving strategies. Ones that would be even less likely to work.

This model of attribution is still used to this day, but has a few caveats. Unlike this study, in the real world, people are not always one or the other. In many cases, and complex problems, it requires using multiple loci of control, but also understanding whether the factors we evaluate and learn from are stable (long term) or unstable (temporary). The stability of an attribution is its relative permanence as a factor. If you know you are good at jumping rope, meaning you have high ability, you have a stable factor to consider your next success with. But, if you attribute jumping rope to how much effort your legs can put out, then the source of success is unstable—effort can vary and has to be renewed on each occasion or else it disappears. We’ll talk a little more about how effort and ability works in a second. The important part is that when it comes to evaluating our part in the grand scheme, the internal locus of control tends to help us perform better.  Let’s look at some examples.

It rained today and we got all wet. We hate that. What if it rains tomorrow and we don’t want to be rained on? Would a belief system around an internal loci of control make sense if we focus purely on ourselves and ignore the sky? Not very well. No matter how many strategies we might attempt based on our own feedback, we are unlikely to change the weather. On the other hand, a person using this internal loci of control might decide to travel away from the storm as a strategy, bring an umbrella, or wear a rain coat, which has some functionality for them but the rain still happens where they once were. Internal loci of control work best when we take into account our solutions but do not ignore the immutable environmental factors.

What about using an external loci of control on task performance? Perhaps we’d like to pick up three items off of our room’s floor within ten minutes. We might begin to generate all the reasons why we cannot, and how far the floor is from our fingers, and how many other factors there are between the items and the trash can, leading to very low performance on this task within a time frame. It’s the room that’s messy. It’s been messy for days now. So messy. So much mess too. What if we just pick up one thing then go back to bed? It’s still messy. Might as well not. Then, we’ve just effectively wasted time generating non-functional thoughts (poor strategy), and nothing was done (poor outcome). That isn’t helpful either.

Generally speaking, when it comes to our own behavior, within our own repertoires of ability, it is wiser to use an internal locus of control to conceptualize our potential impact on tasks and problems. When there are larger systems and unavoidable outcomes from the outside, it does not hurt to consider what lies in an external locus of control. We, as individuals, cannot control everything. But, as we see above, when faced with continual failure feedback, utilizing an internal locus of control early on can help us come up with strategies which mitigate the external circumstances and perhaps land us in a better spot. There is no harm in generating increasingly sophisticated strategies to put ourselves into better conditions and allow the external factors outside of our control to be managed from ever increasing positions of control and strategy on our part. Sometimes when failure comes, it comes after we thought we had a great strategy focusing on our own improvement and it just did not work.

How do we do it? How do we take back some semblance of control when the waves of failures keep coming?

Consider that the concepts of a locus of control, and how our actions impact our goals are called attributions, and have an effect on our future behavior and how we respond to challenges. When we attribute too much to external causes, it can lead us to decrease our attempts. When we attribute too much to internal causes, it can sometimes lead to more sophisticated problem solving, but blind us to other factors might be outside of our control and narrow our perspective too much.

Mediating these attributions not just in the moment of the first failure we come across, but those that follow can help us create a better perspective on our situation. We can also rely on our social circle, relay our experiences, to see if others can help us see what we might have missed and help our future strategies find better success.

  • Evaluate your current attribution and locus of control of the problem.
  • What are some ways we can evaluate our own pattern of responding and improve it? (Internal Locus)
  • What are some environmental factors that impacted our failure that our behavior did not change (External Locus)
  • How do we refine our strategy so that our next attempt can put us in a better position against those environmental variables if they happen again? Can we mitigate what held us back?

Purposive Behaviorism and Re-Training our Attributions

As individuals we can create systems that help us maintain a level of reinforcement to offset failure, and as social creatures, help create an environment of positive interactions that can help us both realize our achievable goals and find strategies to access them. Thankfully, we have concepts and theories at our disposal to explain the hows and whys. Let’s talk Purposive Behaviorism and how we can re-training our Attributional Theories.

If you’ve read my other works on this site, behaviorism itself is familiar to you. Purposive Behaviorism goes beyond the more mechanistic systems of reinforcement and punishment, stimulus and response, that you see in some of the more traditional theories. Yes, reinforcement is important to keep us moving forward. Yes, punishment (failure) can knock us back. But we are human, and complex beings, and a good analysis always takes that into account. From a purposive behavior standpoint, we use goals and work hard to achieve them. That is an intrinsic part of what it is to be human. In older theories by Edward Tolman, the term cognitive map was developed to describe how we do that. Our cognitive map is how we envision our path to our goal. We all have beliefs, unspoken ones, that a specific action on our part will get us closer to an intended consequence or goal. Let’s call these expectancies. They cover both the behavior we intend to do, and the goal we intend to achieve with them. It’s a roadmap. Tolman also believed that we learn from our successes and failures largely through a latent process. There is an automaticity to reinforcement that helps us pick up what has worked and set aside what has not worked, and integrating more cognitive and conscious strategies to what we have learned latently is the best way to move forward. Keep in mind not just what you can remember and consciously recall, but also what might have been learned latently from the experience.

When we map out our actions to meet a goal, we often give ourselves a time frame (hopefully realistic) in which to reach them. By giving our goals, or conceptual map of how we achieve them, a context in time we help judge how to act and what to expect. Generally speaking, acting now is always better than acting later unless you have a more advantageous use of time further along to position towards your goal. With our expectancies in mind, we have our actions, our goals, and our time frame. As adults, we also learn to discriminate effort from ability. Effort can be defined as the amount of energy or resources we must expend to progress towards the goal, while ability may be defined by our existing proficiency or skills that can achieve it. In most situations it is a combination of both effort and ability that help us reach complex goals.

Let’s reintroduce failure here. Let’s say that we mapped out our goal, we made our attempt to the best of our effort and ability, and we find that we simply did not meet success. Perhaps we even see repeated failure. It can be easy to get disheartened, and even travel down that path of learned helplessness, but we should do everything we can to avoid it. Let’s imagine that we did our best to conceptualize our locus/loci of control, and they were as accurate as they could be, but we still missed the mark. We tried, we failed. Let’s say our expectancy, our goal and plan to reach it, is still very important and we do not want to change the goal. How do we use our time most effectively now to get back up and try again? We need to re-train ourselves, and that means re-training our attributions.

Do we have the ability to achieve this next step in our goal? What did our failure show us?

Did we apply the necessary effort to achieve the next step in our goal? What did our failure show us?

Were our attributions on stability based around factors that were stable (ability) or unstable (effort)?

The combination of evaluating our ability and effort and attribute our failure and successes along these variables is key to knowing when something can be achieved alone, if further training, resources, or additional help from others is needed, and how to adjust our plans going forward to include these more sophisticated and evaluated plans that came from the experience. Failure here is a teacher. It’s not always easy to maintain effort after a failed attempt even if the ability was there. To retrain ourselves to analyze our attributions of the failure correctly, we must take some time to evaluate the factors. Use this tool from Dweck (2000), who we saw in that earlier study too, below to take a particular situation you might have been in the past, and see where the attributions fall.

Plug some of your attributions in the grid above and see where they fall. Do you think anyone else evaluating your situation might have a different series of attributions for it?

We tend to get the best results out of ourselves and planning ahead by attributing a reasonable portion our previous successes to internal and stable causes. What went right in the situation within our ability, even if there was an ultimate failure, that we can consistently do again? Example: I might not have won the race, but this was close to my best personal time yet.

When analyzing our failures, we can go wrong in attributing things entirely to unstable and external causes. Things that we see as completely out of our control, and leaves nothing for us to work and grow on. Example: I was going to go in to work today but then the roads were so busy and you know I can’t drive on busy roads…

The take away:

  • Turning failures into successes takes analysis of what happened.
  • Sometimes we analyze the situation well and can think of some improvements for next time focusing on our internal factors.
    • “Stable Dimension” attributions help us reflect on our ability and how to improve it.
    • “Unstable Dimension” attributions help us reflect on our level of effort and if we can improve it next time.
  • If we see many attributions leaning in the unstable or external direction, maybe it could take an extra pair of eyes to help us get a new perspective.
    • Reaching out to a trusted friend, or experienced advisor on the topic.
    • Re-evaluating the attribution by considering internal factors.
  • Learned helplessness can arise from attributing too much to external factors, avoiding evaluation of internal factors, leading to poor problem solving and less sophisticated goal directed behavior.

Getting back up after failure requires analysis of our actions, re-training our attributions to avoid learned helplessness, and consistent effort going forward.

What are some attributions you’ve thought about recently? Have the behaviors you’ve used to reach those goals been effective? Have they been ineffective? How has your belief system on the locus of control impacted the process? Have you utilized others to help you with alternate perspectives?

Comments? Questions? Feedback? Leave them below.

References:

Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied Behavior Analysis. Merrill.

Edward Chace Tolman. (2015). Introduction to Theories of Learning, 302–326. https://doi.org/10.4324/9781315664965-16

Hoose, N. A.-V. (n.d.). Educational psychology. Lumen. Retrieved November 11, 2021, from https://courses.lumenlearning.com/edpsy/chapter/attribution-theory/.

Molden, D. C., & Dweck, C. S. (2000). Meaning and motivation. Intrinsic and Extrinsic Motivation, 131–159. https://doi.org/10.1016/b978-012619070-0/50028-3

Schunk, D. H., Meece, J. L., & Pintrich, P. R. (2014). Motivation in education: Theory, research, and applications. Pearson Education Ltd.

Tolman, E. C. (1967). Purposive behavior in animals and men. Irvington.

Image Citations:

Title image: Getty Images/iStockphoto
Attribution Grid: Christian Sawyer, M.Ed., BCBA

A Dad’s Role in ABA Therapy

/ Chris Sawyer, M.Ed.,BCBA / Leave a comment

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Don’t let the title fool you into thinking about this as a division. A father’s role in therapy is the same as a mother’s role in therapy, or any guardian in therapy. Responsibility, respect, love, and contribution. That should be a given. But sometimes it’s not always treated that way.

A recent intake for a client stuck with me. In this intake we were discussing prior ABA services for the child, and how parent training was done, how programs were generalized, and what seemed to fit best with their prior therapy experiences. It’s good to get an idea of these things. Parent participation is important in therapy. Incalculably important. In this particular one, the father mentioned their prior BCBA tended to discard his suggestions on targets, or socially relevant behavior goals. This caused a second or two of an awkward pause where the mother jumped in with a humorous aside about how the BCBA got along much better with her. The thing is, you could see that the way the professional handled that situation limited the father’s future enthusiasm to engage with the process. Some people could often mistake that as the “Dad being distant” cliche, and everything continues as these expectations play out. The problem is, we had a parent interested in a process, who had a voice, and that voice was silenced (ignored) and guided to a false consensus.

There are sometimes these unspoken things, or expectations, in parent roles. Some are traditional things that stick around, some are just artifacts of a bygone era that do more harm than good. Rooting those kinds of things out and making more functional alternatives tend to help the whole process along, relationship wise, responsibility wise, and makes people all together wiser about how they’re behaving and what the expectations are for how therapy will work. Parenting is sometimes rule governed after all. In therapy, professionals, like BCBAs, can sometimes make unspoken rules with unintended consequences. Inferences here. Ignoring something there. The feeling I was getting from this situation above was that there was not an equal input in the last experience with ABA therapy. So, with a little back-stepping to basics, I wrote down all the suggestions both parents had for goals, and funny thing was, Dad said more, and the Mom was surprised. We all learned something. It sounds like a small thing, but imagine what a trend like this could have been long term.

I suggest some very simple ground rules, which should be very obvious:

A client’s mother can have great ideas about therapy goals.

A client’s father can have great ideas about therapy goals.

Any other suitable guardian can have great ideas about therapy goals.

The client themselves can have great ideas about therapy goals.

 

Sometimes these suggestions don’t make sense to us as professionals, sometimes they aren’t age appropriate, sometimes they don’t fit current skill levels, but we don’t just ignore them and silence the people who are invested in the client’s well-being and growth. The whole point here is that there should not be this great distinction between what the Mom can contribute, and what the Dad can contribute. Once we assume one has better ideas, or more time, or more commitment, we do a disservice. Situations may play a role in what happens in actual practice, but those are going to be based on actualities, and not preconceptions. Preconceptions acted on as though they are obervations are not behavior analytic.

Now, there also may be things that we notice between male parents and female parents that are a little different. Sometimes these things are stereotypical. Sometimes the interests follow expectations that we see generalities of in our daily life. We need to make sure we don’t assume too much with these. Treat every situation as though you will be proven wrong. Treat every situation as though you will learn something. Assuming too much is where we always get it wrong. Overlooking things is not scientific.

Data Point of One (Personal Experience Talking)-  On a case, I had a father once who had a different view point on some social goals. There are some situations where the current social goals put the client in what the father called a “weak position” to their peers, based on some peer interactions that had gone a bad route.  At face value, we could either say “NO! The client is expressing themselves! That’s good! What happened wasn’t their fault! Get out of here with that victim blaming!” or, we could take a minute and understand the meaning and sentiment of that worry. The client could be taken advantage of. Social hierarchies exist. Kids take advantage of other kids. Kids hurt other kids. The specific operant behaviors we were teaching here might actually be reinforcing peer aggressive/hurtful verbal behavior. It’s possible. We should probably take a look. Behavior does not occur in a vacuum. It ended up being more complicated than that, but the analysis was warranted. It helped.

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Both parents can contribute. No matter the gender, no matter the outlook, most of the time if you find a parent who cares about their child enough to attend meetings, put the time into the trainings, and are enthusiastic about transferring and generalizing skills, you’ll find someone who can make a contribution to the growth and progress that can not be underestimated. The more hands on deck to getting the client the skills the better. We want more people on our team. We want more people showing love to the client to get them where they can thrive. A large support structure that loves and cares for an individual can make all the difference. We as professionals don’t get to decide who gets a voice and who doesn’t. That’s the lesson.

 

Comments? Questions? Thoughts? Leave them below.

 

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Getting a Behavior Analyst House-Call

/ Chris Sawyer, M.Ed.,BCBA / Leave a comment

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Behavior Analysis is different from other psychological therapies. First, it is considered a natural science, meaning that its interventions rely in manipulation of real world variables that can be observed. This removes some of the stereotypical therapeutic long talks on a couch for viable behavior analytic therapy, but don’t sell behavior analysis short just yet.

The best evidence based practices in applied behavior analysis can be found in the natural environment, both studying participants behavior across those environments. It looks at the patterns of either prosocial behavior that can be therapeutically reinforced , and identification and reduction of maladaptive behaviors which get in the way of a fulfilling life.

One of the founding psychologists of behavior analysis, B.F Skinner, wrote in “Science and Human Behavior” (1951) about both the experimental setting for behavior analysis, and the paramount importance of seeing behavior in the environment in which it behaves. Doing tests in a lab may be helpful to get behavior analysts some solid and clinically controlled data sets, but it could never tell them if those skills or patterns would generalize a certain way in the world outside. There’s an importance to that. One of the founding dimensions of behavioral analytic science demands that the products have Generality meaning that the effects of therapy occur across environments and time. The benefits of therapy must outlast the clinical visits. This is helpful to the clients and consumers of behavior analytic therapy (ABA) for obvious reasons; you want the therapy to work in the places you need it most.

ABA practitioners use two broad tools to shape the direction of therapy a Behavior Plan to identify maintaining factors for maladaptive behaviors, and a Skill Acquisition Plan to build up the better patterns, skills, and coping behaviors to replace them. It is all about identifying the problems fast, and implementing actionable change. To that end, they need all the information they can get. Location matters.

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When it comes to the location of services, both for client/consumers, or perhaps the children of client/consumers, age becomes a factor in where this therapy takes place. In many cases this could happen in a school setting, or clinical center setting. This is a practical and commonplace service location for clients of therapy of younger ages. The school setting does have naturalistic opportunities that the clinical setting does not, and having the opportunity to receive therapy in both has its benefits. Clinical settings can focus on the skills that can be practiced with controllable conditions and stimuli that do not have the scheduling drawbacks of an academic setting. School settings have the benefit of natural peer environments, and natural contingencies for task demands if behaviors are dependent on those factors. What is often overlooked, however, is the home setting. I practiced as a School Counselor, and although certain types of therapy worked in the school setting and helped the students, once they walked out the door, the practitioner had no idea. It was all self-report from homes, and those can be misleading.

The benefits of having a house call from a behavior analyst (BCBA), and getting ABA therapy at a residence, is that the practitioner can see the conditions outside of the clinical and academic sphere that may be relevant to either stifling patterns of prosocial behavior, or feeding into the maladaptive behaviors. Sometimes the home environment is rich in information and reinforcement history that an analyst can work with. Routines, schedules, and practice can all be built into a home visit to work on the things that need the most work. Sometimes the privacy and comfort of the home also helps with going through dry runs of new skills without the social pressure of the outside world. When a Behavior Analyst comes in through the front door they are interested in getting to the bottom of the problem behaviors, teach socially relevant alternatives, and most of all, to help. I’ve seen first hand how just a change to familiar scenery can open up dialogue and planning for therapy directions that might be uncomfortable, or even embarrassing elsewhere, so never underestimate the power of an environment change on behavior.

Some Practitioners might not be able to deliver consistent services in the home, but even one occasional house call, one single visit, could open the lens on new conceptualizations on the therapeutic framework. I’ve experienced this countless times. As a practitioner, you think you know what’s going on, and then you’re in the client’s place of residence and a big piece of the puzzle falls into place. This is advice to any behavior analytic practitioner; if you have the opportunity to make that house call, don’t wait. It could change your entire idea of what is going on and save hours on dead end functional analysis hypotheses. House calls can also get the broader family involved with services that they might have otherwise been unfamiliar with. This opens up dialogue, and questions, which could lead to greater support both inside and outside of the home. There is a well known tenant in behavior analysis called dissemination. That means, this natural science works best when people know about it and understand it. Spreading the word, and being correct in the delivery of what ABA therapy is, is important. There is no short supply of misinformation out there. A home visit with the family, willing to participate, can break down the barriers of hesitancy, and show just how effective and useful this therapy can be.

So potential clients and consumers? If you can swing it, call for a home visit.

Behavior Analysts and ABA practitioners? Don’t be afraid of house-calls. You’ll be kicking yourself for not doing it sooner.

Questions? Comments? Thoughts? Leave them below.

Interest in ABA therapy for resources in getting services, or practicing? Feel free to email the address below.

References:

Cooper, John O, Heron Timothy E.. Heward, William L.. (2018). APPLIED BEHAVIOR ANALYSIS. S.l.: PEARSON.

Skinner, B. F., & Skinner, B. F. (1951). Science And Human Behavior. Riverside: Free Press

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Overcoming the Fear of Failure

/ Chris Sawyer, M.Ed.,BCBA / 1 Comment

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This is a topic I see very often in clinical practice. Not only that, but it affects everyone at one point in their lives. When I am working on skills with my clients who are able to vocalize and express these fears, I see a pattern inherent to everyone who has ever encountered something new. In Applied Behavior Analytic research, sometimes we like to operationalize this phenomenon as “aversion”, or “presentation of an aversive novel stimulus”. Whatever we call it, it is the same thing. Engaging in something new and uncomfortable in a goal directed way is a challenge that we have to confront. Clinically, I prefer to have the individual guide their own process and become aware of their own specific aversions and behaviors. It makes the practice of confronting these stimuli as self-initiated, and self-guided as possible.

I prefer the word confront because it has a better ring to it than “desensitization”. When it comes to coming face to face with a stimulus or situation where we have to either perform or adapt, confront just seems to carry the operant theme more than the passive “desensitizing”. Failure is a scary and aversive thing.  We can define it as a condition where our operant behaviors are unsuccessful. Efforts which are not reinforced. It’s perfectly natural to want to avoid a contingency with no reinforcement. When we face something we are afraid of, or a new situation where we might not be sure we can succeed; we are facing that fear of failure. Maybe it is a fear of not being able to complete a required activity of success, or putting yourself out there socially and being received amiably. There is something universally human to that kind of hesitation. In ABA we call that an “escape-maintained” behavior, and when the behavior serves no real purpose to protect us, it tends to hold us back. When failure is that fear, then we tend not to even try.

In clinical practice, be it Applied Behavior Analysis (ABA) or any other Cognitive Behavior Therapy (CBT) the advice is all the same; it takes presentation (and sometimes repeated presentation) of that stimulus in a controlled situation until that aversive situation becomes neutral. This is called controlled exposure. That is where the real progress happens. When someone meets that situation, faces it, and can come through the other side fearing it less (or finding it less aversive), it is a step in the right direction. You may also hear the term “graduated exposure”, which denotes the concept of fading in stimuli or related stimuli in from least to most in order to acclimate in steps. A common example is if someone is scared of spiders or animals, they would be shown a picture first across the room, and gradually get closer to the picture before moving on to any examples of the real deal. Habituation is the term commonly used for becoming used to something, to the point where the stimulus becomes tolerable, if not neutral.

These same principles can be used when actively trying to overcome a fear of failure too. Generally, we come across things that are new to us. These can be either unconditioned stimuli (things we are “naturally” fearful of) and conditioned stimuli (things we have learned to be fearful of). Public speaking in front of large groups is an example of an unconditioned stimulus (for some, but it can be conditioned for others) while taking tests is a common example of a conditioned stimulus. Both present a challenge that we have to act on (engage in operant behavior) in order to be reinforced. Be it someone you are helping in clinical practice, or yourself, you can use these same foundational principles of graduated exposure. If the situation is not reinforcing in itself, keep in mind that you can always improvise your own reinforcement (reward) in order to make adapting easier. Using reinforcement alongside challenging situations can make them less aversive through a process called conditioning. The act of practicing this process on yourself is called self-management.

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Consider these steps when trying to formulate your own graduated exposure:

  1. Find the situation which you feel is important to engage in or achieve (Target).
  2. Break it down into it’s smallest components (Task Analysis). 
  3. Pinpoint which part, exactly, is causing the most aversion or fear (Aversive Stimulus). 
  4. Document, to the best of your ability, the behaviors you engage in along the way (Data Recording/Self-Monitoring). Do these behaviors help, or do they hinder? 
  5. Practice engaging with a facsimile or similar situation where the stimulus or stakes are not so high (ie. If public speaking is the target try practicing a speech in front of 1 person first). 
  6. Reinforce (reward) any toleration or approximation of success! This is the most important step. 
  7. Gradually shape these practice simulations to simulate the “real” objective as closely as possible. 
  8. Do not rush it. Challenge yourself, but be mindful that this is a process, not a race.

Take it slow. Document everything you can. Learn. Improve. The process is where the fear of failure is overcome. Often it takes more than one contact with the situation to get accustomed. I’ve used this process on myself more times than I can count. As a person who has found large exams, public speaking to crowds, public competition, and even engagement in new and unfamiliar situations; the end-goal is all the same. It is something that is worth facing because the outcome is a socially important, or beneficial to us. The aversion, or fear, is not helpful or adaptive. Facing these situations and designing the process oneself is empowering.

Self-Management is one of the greatest strategies in ABA. If someone can find a way to manage their own behavior successfully then it is the ideal situation. Self-monitoring and self-management also have the unique bonus of being able to handle what Behaviorists call “covert behaviors” (thoughts, etc). Covert behaviors are things that are not visible to outside observers but are still able to be tracked and recorded by the person experiencing them. Accuracy and specificity is important here, and can vastly improve a personal insight into their own patterns of behavior. This doesn’t have to be a single person job either! Even though someone can monitor their own behavior, they can also bring trusted friends/family/cooperators into the process of reinforcement and help to keep them on track.

Independence, and knowledge about yourself, while overcoming a challenge.

What could be better?

 

Comments? Questions? Leave them below!

 

References:

  1. Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied behavior analysis. Columbus: Merrill Pub. Co.
  2. Wood, S. E., Wood, E. R., & Wood, E. R. (1996). The world of psychology. Boston: Allyn and Bacon.

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Behavioral Therapy (ABA): Beyond Ethical

/ Chris Sawyer, M.Ed.,BCBA / Leave a comment

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This is an opinion piece which was inspired by a few sources recently, which I believe although anecdotal, has some insight from 10+ years of doing therapy, both behavior analytic and counseling. I was reading an article that came up online, one of those anti-ABA groups that search the internet selectively, for studies that support their views on this specific type of therapy. This article in specific was called “Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis”, and it seemed independently researched and not peer reviewed, whose findings were based off of subjective surveys, with questions worded negatively suggesting inherent bias. I am not here to review it. Suffice to say, I found it unconvincing, but it did raise questions. What if there were practitioners out there that were causing harm? Subscribing to a set of ethics is not too difficult, but if you don’t know why, you might lose sight of the principle of it being there; to do the right thing.

In Applied Behavior Analysis, there are rigorous codes of ethics. Codes that have to be studied and make up a large portion of the board examination, and beyond that, ever re-certification cycle requires hours of continuing education on the topic. However, I find, that it’s still hypothetically possible to meet all of that ethical rigor, and still fall short of doing a proper job of maintaining a positive and supportive relationship with clients. Nothing inherently dangerous, or harmful, per say, but still leave a neutral or negative view of the experience down the line. I don’t think any practitioner, BCBA or not, would want something like that if they could help it.

A famous humanist psychologist named Carl Rogers came up with one of the best precepts for therapy I’ve ever heard of. He called it ; Unconditional positive regard. It is exactly as it sounds; acceptance and respect from the clinician towards the client, no matter what. It doesn’t have to be continuous genuine joy, or merriment for every second of each session, but it does require the clinician to have one thing if they want to keep this therapeutic relationship going, and expect it to work well; positive regard for that individual no matter what happens in that session. Mainly, because all therapy, even ABA, is a relationship. It requires two people, or even more, and those interactions are in a sense what we model for our clients. It’s important that they know that they are respected, and the door will be open every time for them, unconditionally, and it has to be genuine.

There are situations that can cause some friction in any therapeutic relationship. Every single therapeutic field has it. With ABA it takes on a more difficult form, I think, especially when some of our clients do not have language, or any interest in forming a rapport, or even interest in any other person at all, therapist included. Sometimes clients can get aggressive; both verbally and physically, and sometimes therapists take on both kinds of scars. It’s not easy work. Sometimes that unconditional positive regard takes some effort. Behaviorally, you could call that all of the operants in your “positive regard” repertoire. Maybe it’s how you look at the client, or how you speak, or the tone you use, or even the direction of how you present your session. If it’s not aiming for the betterment of your client, then that’s the wrong direction.

Another concept from Carl Rogers is, the client has to want to change, or engage in therapy for it to work. B.F Skinner also talks about this type of engagement in his book “Science and Human Behavior”, but from a behavioral standpoint it all comes down to the same thing: positive reinforcement. There has to be something there that the client wants, for this change to take place. Don’t punish when you can teach instead. With non-verbal clients, sometimes they might not know why they are there, or understand what exactly is going on; we can’t say. It’s unspoken, and we can’t guess at it, but what we can do is make sure that their process is one that leads them towards that independent and socially significant lifestyle without harm, interpersonal or otherwise. Behavior change is hard. The targets we introduce, even if we aim them for exactly their level of proficiency, will challenge our clients, and we can not underestimate the effort in that challenge. We have to use positive reinforcement that works, and is strong enough to make the client “happy” to keep trying. That is ethical, but more than that, is the right thing to do. In ABA we are taught to avoid “default technologies”; unnecessary punitive procedures of disciplining, or appeals to authority. I can not imagine a condition where we would need to make a target where a client does something solely “because __ says so”. Would we accept that kind of contingency without questioning it? Of course not. As practitioners, we have to look beyond the short term and away from the older forms of discipline to help individuals go as far as they can in their lives. Long term strategies kept in mind while working on the short term, and while all that is going on… unconditional positive regard, positive reinforcement, respect for our clients and respect for what we are doing.

I believe this form of therapy is a force of good, and progress, in this world. It is evidence based, and supported tirelessly by decades of researchers, for the purpose of getting it right. When we use a therapeutic technique, we back it up. Every time. And always for the betterment of the client. That’s the point of removing the guesswork and ambiguity of the techniques; so we can shape it to work for that individual. We make it applied. Practitioners are trained endlessly on single subject designs for the purpose of avoiding the rut of comparing one person to another statistically. That puts the blinders on. The individual client comes to us for their progress, not in regard to their cohort. From that perspective, every individual does deserve that level of respect and regard for their future, and their life. As a practitioner, that’s a large responsibility, and it takes going beyond just ethics. It’s not just following a guideline. It takes doing the right thing, and knowing why.

Sources:

COOPER, JOHN O.. HERON, TIMOTHY E.. HEWARD, WILLIAM L. (2018). APPLIED BEHAVIOR ANALYSIS. S.l.: PEARSON

Rogers, Carl (1995). A Way of Being. Houghton Mifflin; 1 edition (1980)

Skinner, B. F. (1953). Science And Human Behavior. Riverside: Free Press.

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