One Size Does Not Fit All

Is This A Flaw In Psychology & Education?

I wonder about the universality of the principles which provide the basis of Behaviour Modification Therapy.

Behaviour Modification is firmly based on the concept that behaviour can be encouraged by positive reinforcement and reduced by withdrawal of positive reinforcement.  I agree with this, it often works.  However the theory originated when working with patients who were damaged by negative upbringings; abusive or neglectful parents or even just good parents who through circumstance or lack of knowledge accidently give insufficient or ineffective reinforcement.  The assertion that Behaviour Modification Therapy is a universal panacea is predicated on the belief that all of everyone’s behaviour is based solely on a lack of or inappropriate reinforcement in their formative years.

Behaviour Modification Therapy probably works well with patients from dysfunctional families, even if the dysfunction is relatively slight and not anyone’s fault.  But I seriously question it’s efficacy on patients from a “functional” homes.  A child or animal starved for affection may do anything for the attention of an authority.  Will a secure, confident child (or for that matter a secure, spoilt lap dog) be as motivated

I’m not saying a happy child doesn’t try to please others, or enjoy praise, of course they do!  Most of the time & especially in a pinch a happy, confident child will also be a helpful, obedient and generous one.  But approval has got to be less strong as a motivator, especially when there are other strong emotions involved.  Both avoiding pain or fear and the anticipation of pleasure can in these circumstances be higher priorities.  For example; if presented with an opportunity to eat an extra sweet will the prospect of short term disapproval by doting parents be considered too high a price to pay?  Parenting would be so much easier, but I doubt it.

Now this is usually not an issue; happy, stable, confident people are not often given Behaviour Modification Therapy in a major way.  But I believe this is strong evidence that approval is not the only shaper of behaviour.  Like many other things if abuse or neglect are present they produce much damage, like a bullet or a bacteria the presence creates the damage.  But people that haven’t been shot don’t need surgery to remove the bullet.  And how effective will Behaviour Modification Therapy be against Post Traumatic Stress, depression caused by chronic illness or profound injury, or aberrant behaviour caused by Psychiatric disorder or induced by external agents (eg. drugs).

ASD along with other disabilities, illnesses and injuries produce pain, fear and other problems that can be powerful motivators.  If the effected person is confident in their relationships how effective is Behaviour Modification Therapy going to be?  Little when gaining attention is not their primary goal.

Stop!  I know it is not that simple.  Actually because anxiety, inability to communicate and feeling ‘different’ are common amongst people with ASD and other disabilities many of them respond extremely well to Behaviour Modification Therapy.  But only when applied to the right behaviour.

Behaviour Modification Therapy, Cognitive Behaviour Therapy, exposure therapy, desensitization, medication, mnemonics and many other medical, psychological & related tools and methods can work wonders.  But any of these tools work best when applied intelligently & in combination to the right areas.  Psychological theories like fire make an excellent servant but a terrible master.  In other words great tools nightmarish as exclusive schools of thought.  I think the best therapists are those who are open minded, & freely change their therapy tools according to the patient, the circumstances and the success of treatment.

Unfortunately, & this is one of the reasons I never finished my Psych degree, too many Psychologists & most Psychology lecturers claim their preferred theory is the universal cure.  In the case of adherents to Behaviour Modification Therapy any aberrant behaviour is caused by lack of positive reinforcement, usually by the parent, and thus can be cured by instituting positive reinforcement regimes.  Even in cases where the principles of Behaviour Modification Therapy can be useful in changing problem behaviours; if the cause of the behaviour was not inadequate positive reinforcement then the suggestion that it is the only cause can be devastating to the patient and their family.  A good therapist considers other possible causes, especially as resolved sensory or pain issues may continue to interfere with the patient’s progress.  The best therapists keep all this stuff in mind when choosing, implementing & assessing the tools or methods they use on each patient.

Unfortunately other therapists, and believe me I have met dozens of them, claim that if the patient doesn’t improve under their favourite regime then it is the patient or their carer at fault, not the method, never the method.  They blame lack of effort, incorrect use or inadequate practice, they accuse their patients and/or their patients’ families of not prioritising, of being obstructive, lack of adequate care by parents, or enjoying being sick by patients.  I, by my own or my family’s therapists, have been accused of all of this plus physical abuse, unrealistic expectations, Munchhausen’s by proxy and more, I can think of 18 therapists right now (can’t name them, blocked most names out).  It has to be the fault of the patient or support person because this “works on everyone”.  My husband’s last therapist; a proponent of Behaviour Modification Therapy, said that because they were focussed on behaviour change they did not need to discuss feelings including why my husband felt the therapy wasn’t working.  His answer to lack of progress was to try harder, put in more effort, stop sabotaging himself, or believe more.  We have learned to try and avoid any therapist that preaches any universal cure all.

You can find this kind of Universal cure attitude not only in psychology, but in education, social planning, government policy & elsewhere.  Theories based on an aberrant minority are universally applied.  In education practices devised and successful in very bad schools are greatly applauded (as they should be) and used as blueprints for other schools (not always a good idea).

I am very cautious about any new wonder in education method, but am especially cynical when the wonder originated in a “bad” school.   Schools with a reputation for chronic low results have a high correlation with unusually high problem behaviour & community problems.  Problems in the community, a concentration of parents with substance issues, violence or other problems lead to a lack of resources & support, a higher percentage of students with significant behaviour problems, in turn leading to increased demands of time and resources, leading to demoralised staff & students.  The downward spiral can be difficult to stop, but the implementation of any program that gives direction & confidence to the staff will lead to greater discipline and better morale for students, resulting in great improvements.  Any educator who creates &/or implements a workable system that reverses the spiral is to be admired and feted.  Good programs like this should be trialled in other schools, but in schools with similar issues.  A program that works in a rough inner city school with high illiteracy and violent incidents is not necessarily relevant to a school with a supportive community, affluence, low levels of impaired parents and no significant behavioural problem.

Surely the idea that if something cures someone who is impaired will therefore help someone with less, different or no impairment is surely insane.  After all we don’t give antibiotics to healthy people.  Oh wait, we do, all the time, that’s why super bugs are evolving.  Our society is cracked!