Behaviour Modification Therapy - Case Study Example

Behaviour Modification Therapy As an individual working with children and families, it is important to have at least a broad understanding of the various theories and approaches that can be adopted for various situations. While some may feel a single approach is suitable for all cases, even this single approach would necessarily involve a wide flexibility in technique if it were to be at all successful for multiple clients. The importance of being aware of new theories, practices and studies cannot be overstressed. “To travel at all is to hold ideas about the behavioural and social terrain over which we journey. To show no interest in theory is simply to travel blind. This is bad practice and unhelpful to clients” (Howe, 1987: 9). The degree to which an individual social worker may have the opportunity to explore different approaches may vary based upon the political and organisational policies and framework of their agencies, with those associated with service-user led voluntary projects generally gaining a higher ability to use their own discretion than those employed by local intake teams (Blewitt, Lewis & Tunstill, 2007: 4). According to Halmos (1965), social workers in the 1950s were defined more according to the agency that they worked for than the work that they did, a condition that has only become more exaggerated in recent years. Despite the constraints on their time, resources and prescribed approaches, most studies continue to show that practitioners would much rather be employed with agencies that allow them to work in a reflective, relationship-based manner (Munro, 2004). Behavioural therapy provides this type of working relationship. To fully understand this approach, it is necessary to first define what is meant by the term ‘behavioural therapy’, understand the background from which it came, the theories that contributed to its development and determine those situations in which it can best be employed by defining its strengths and limitations before it can be applied to a hypothetical case study. Definition The primary purpose of the social worker is to educate families on how to use more positive means of dealing with issues of all kinds. “Although there are many tools available to the social workers to help bring about change, one of the most popular is generally labelled behaviour modification. This method is defined as ‘the systematic application of common sense wrapped in psychology’s brand name, behaviour modification” (Weathers, 2007). Behaviour modification can be loosely defined as a means of targeting specific, observable behaviours and employing deliberate means to effect change. According to Mather and Goldstein (2001), this method is largely based upon the idea that consistent rules are typically applied to individuals’ behaviour patterns. With this understanding, behaviour modification theory further indicates that, this being the case, there should also exist various means of defining, observing and measuring different behaviours in order to determine the consistent rules that have made them manifest. Finally, with the means of evaluating the various contributing factors to specific behaviours as well as definition of the observable outcomes, effective interventions can be established that will quickly and easily change undesirable behaviours. In this process, reinforcement techniques are used as a means of encouraging and strengthening desired behaviours, sometimes as indirect counters to poor behaviours, while punishment can be used to weaken undesirable behaviours. This type of therapy treatment has shown itself to be highly effective when it is appropriately implemented. A great deal of the therapy approach depends upon the involvement of a conscious choice made on the part of the individual with the aberrant behaviour. This is indicated in the literature by the use of the term ‘cognitive’ applied to the overall approach. Proof of its effectiveness is hinted at in the fact that many individuals working within the social care field have begun working to implement cognitive-behavioural therapy (CBT) training programmes within their units. “CBT approaches to foster care training derive from a skill-based training format that also seeks to identify and correct problematic thinking patterns that are associated with dysfunctional behaviour by changing and/or challenging maladaptive thoughts and beliefs” (Macdonald & Turner, 2005). However, this technique is not a simple thinking exercise engaged between the therapist and the individual client. Instead, “understanding and ‘insight’ needs to be heavily supplemented by an active, or ‘doing’ element – what Bandura (1977) calls a ‘performance component’” (Sheldon, 1982: 11). Without action, the treatment option is little more than an exercise in philosophical reasoning. Background Theories Behaviour modification therapy is based largely upon the concepts of social learning theory brought forward by Alfred Bandura (1963) which emphasises much of what has already been discussed regarding the definition of behaviour modification therapy – namely, the importance of observing the behaviours and emotional reactions of others. “Learning would be exceedingly laborious, not to mention hazardous, if people had to rely solely on the effects of their own actions to inform them what to do. Fortunately, most human behaviour is learned observationally through modelling: from observing others one forms an idea of how new behaviours are performed, and on later occasions, this coded information serves as a guide for action” (Bandura, 1977: 22). According to Bandura’s theory, observational learning is the result of continuous reciprocal interactions between cognitive, behavioural and environmental influences primarily occurring through attention and the observer’s particular abilities to synthesize what has been observed, retention of the knowledge thus gained, motor reproduction in terms of a physical action or deliberate attempt to duplicate what has been learned and motivation to continue this behaviour. This concept is echoed in the work of Payne (2005) who indicates a great deal of interrelationship between the various models. From the theory’s early development, it was linked closely with the concept of behaviour modification (Bandura, 1969) by building upon the earlier strictly behavioural ideas of modeling concept brought forward by Miller and Dollard (1941). In addition to behaviour modification, social learning theory has also been applied to the understanding of aggression (Bandura, 1973) and has served as a foundation for many training programs. Most recently, Bandura has used social learning theory as a foundation for studies into the idea of self-efficacy (Bandura, 1997). According to social learning theory, there are three key principles that contribute to a higher level of learning. These indicate that observers who are similar in some way to the modeller and the modeller has a higher perceived status, if the action observed leads to some kind of functional value and if an action is likely to result in the reward of something that is valued, people are more likely to intentionally try to duplicate the observed event, and participation in the action is necessary to obtain a higher level of understanding and retention. As the discussion has indicated, a large portion of behaviour patterns are based upon an individual’s understanding of the observed actions. This understanding thus depends a great deal upon developmental theories. According to Hutchison (2003), a child only begins to understand cause and affect relationships late in the sensor-motor period of life, and remains incapable of understanding the thoughts and feelings of others as well as the ideas of classes or sets through the pre-operational period. Children remain incapable of understanding abstract concepts throughout the operational period, not gaining the ability to think critically until well into the formal operational period beginning at roughly the age of 11 (Hutchison, 2003). It is important to keep these concepts in mind when determining the behaviour modification therapy approach because a child may have a different interpretation of an event than an adult who is capable of gaining different insights as a result of abstract relationships. While issues remain in trying to understand a child’s perspective when attempting to model adult behaviours, there are equally issues to be overcome when dealing with adults. There are two factors to consider when a social worker is working with an adult. The first is the social worker’s own tendency to view all behaviour as a symptom of external psychological issues, but other factors could be involved that will be missed. The other issue is a number of studies that have indicated adults have a tendency to become stuck in a particular pattern of behaviour from which they are unable to separate (Belsky, 2002; Sheldon, 1982). These patterns can then be the result of a behaviour learned so long ago that the underlying factors cannot be found or that the attention becomes shifted away from the current issues and factors that have exacerbated these behaviour issues. These studies indicate the importance of remembering to consider external factors of behaviour patterns as well as having faith in the individual’s potential to bring about real change once these issues have been examined (Belsky, 2002). Indications It is not always enough to consider that behavioural modification therapy will be the only conceivable answer regardless of what the problem is, even when it has been determined that the problem is not physical in nature. “It is important to look carefully at what behavioural methods have to offer, not just because they are ‘new’, or attractive tough-sounding at a time when this is very much in fashion, but because they are based on a steady accumulation of reliable knowledge which suggests that they are both wide in scope and effective in application. The decision to use them should not be a question of belief, or affiliation to a new movement, but an empirical one. On the evidence we have at present, they are, quite simply the most sophisticated and reliable methods available” (Sheldon, 1982: 2). Instead of selecting a particular approach because it is the ideology that is most comfortable to the social worker, the nature of the problem needs to be fully assessed, including the various environments that may have an affect on the behavioural outcomes. The approach taken should be based on empirical data that indicates it is an appropriate approach for the given situation only after the situation has been fully assessed. “Behaviour methods can be best applied in therapeutic social work, where they can provide an objectively superior psychological basis for social casework” (Sheldon, 1982: 5). Therapeutic social work is strongly based on the formation of a relationship between the social worker and the individual. In this framework, the key elements of relationship are defined as “attention to basic need, response to aggressive impulses and the lessening of punitive self-criticism” (Sudbury, 2002: 149). Because of the tremendous amount of support such an approach requires, coming from various aspects of the client’s personal environments, this approach is said to be most effective when involved in larger agencies with a high level of staff support and a strong supervisory element that can regulate suitable work arrangements and expectations. Strengths Behaviour modification therapy has been shown to work quickly, produce long-term desired results and to benefit the individual overall. It is a less invasive therapy in that it doesn’t necessarily require drugs to be effective and, when drugs are required, studies conducted on AD/HD diagnosed patients indicated that much lower doses were necessary (Pelham cited in Contrada, 2004). This is seen as a tremendous improvement especially when compared to older techniques. “[Behaviour modification] does not ordinarily short-circuit whatever capacities for awareness and reflection, for approving or disapproving motivation, for identifying with or resisting one’s own behaviour, which the subject possesses, at least it does not short-circuit them in the ways that psychosurgery, psychotropic drugs and electronic stimulation of the brain do” (Steinfels cited in McCrea, 1975). In addition to these benefits, the principles of behavioural therapy are relatively simple to understand, even to the extent that an individual familiar with the concept, may begin to bring about change on his or her own. This increases the perception that this form of therapy increases the potential for individuals to retain their autonomy as separate and independent entities. Finally, this form of therapy has been found to “restore aspects of human functioning which are undeniable conditions of any sort of autonomy. It can overcome massive obstacles to autonomy” (Steinfels cited in McCrea, 1975). However, the issue of autonomy is also the subject of many of the cited limitations of this approach. Limits One of the major concerns regarding behaviour modification therapy is its ability to remove the concept of free will from the vernacular of the individual client. “How does one who has as his (her) goal the development of children into bright, creative, free, and open individuals reconcile this goal with a program that controls and manipulates behaviour? Behaviour modification can indeed control behaviour to such a degree that we can create, maintain and eliminate almost any behaviour that we can define and measure. Behaviour modification can take freedom of response from the child and place it into the hands of the controlling teacher” (Cote, 1973: 45). While the tendency for adults to become more set in their behaviour patterns makes it less likely that an individual social worker would be able to completely change a specific behaviour to go against the will of the individual client, the potential for such a scenario exists within this method and highlights the need for a high level of ethical policies and practices in association with the treatment. In addition, there has been conflicting evidence regarding whether this technique actually has the type of quickly implemented and long-lasting effects that have been associated with it. In a study conducted by Macdonald and Turner (2005), children who were looked after in social care showed little effect in psychological functioning, the extent of their behavioural problems or their interpersonal functioning after training interventions had been implemented. “Results relating to foster carer(s) outcomes indicate some improvements in measures of behavioural management skills, attitudes and psychological functioning. Analysis pertaining to fostering agency outcomes did not show any significant results” (Macdonald & Turner, 2005: 1265). As a result of their study, as well as their investigation into the relevant literature as an element of the study, the authors concluded that there is not enough evidence available indicating a definite positive outcome of CBT-based training interventions given to foster care givers. While this result may be debatable, especially considering the amount of supervisory support provided foster care providers, it does highlight the importance and dependence on a high level of support for this method to be effective. Techniques According to Blumer (1969) we need to understand the environment, the interactions and the meaning individuals attach to it and how this in turn formulates behaviour. Therefore, when beginning work with an individual client, observations must be made of the various behaviours displayed and a particular one should be targeted. Then the behaviour must be observed in a variety of settings in order to develop a consistent description and concept of why this behaviour might be manifesting (what seems to be the motivational factor) and whether external actors are contributing to the problem. For example, a child that is constantly reported to shout out in class may be perceived to be acting in aggression or desperately seeking attention, but the child himself may be under the perception that this is appropriate behaviour based on actions he has seen of his father at work in the pits of the stock exchange, where shouting out is a daily aspect of work responsibilities. In making this determination, it is important to keep in mind the perceptions of the child in question, as he may not be of an age where he can grasp concepts that distinguish his father’s job description from his own duties as a student. With the problem identified and the environment understood, the first stage of Egan’s three stage approach has been accomplished. This approach is outlined by Coulshed and Orme (1998). While the first step explores the problem, the second step works to help the individual understand the situation. In the previous example of the child who consistently shouts out in class, the therapist might explain to the child that the classroom is an entirely different situation from the place where his father works and therefore, different rules apply. In addition, discussing this perception with teachers may help them to feel less antagonistic toward the student and more willing to help him learn new, more appropriate, behaviours. This then leads into the third stage in which goals are set, resources are evaluated and eventually, outcomes are measured. The course of treatment itself, however, requires that the student take an active role in the behavioural change that is expected. While teachers can help him to curb his natural tendency to shout out by calling on him quickly when he remembers to raise his hand, the student must also have motivation to develop more appropriate classroom behaviours. Small rewards, such as the teacher calling on him quickly when he raises his hand, can be effective as can larger rewards such as a special lunch with the teacher, a sticker for good listening skills or another special activity that appeals to the individual child. It should be noted that without the cooperation of the teacher, this approach will not be effective, which highlights the importance of including the teacher in understanding the child’s perspective on their behaviour. Finally, work conducted by Zimrim (1984) suggests that good behaviour can be encouraged through human contact with others who already exhibit the positive behaviours desired. A fostering of friendships between the loud student and other students to whom they already have some relationship can further facilitate change in this scenario. Conclusion It has been shown that while behaviour modification therapy can be a very effective tool for bringing about behavioural change, it is neither a cure-all nor always the best option for a given situation. While it seems to have quick results and long-lasting outcomes, studies have shown that there is not sufficient unanswered evidence that indicates this is necessarily true. Questions have been raised as well regarding the ethics of its use and the best means of protecting the individual’s freedom of choice. Because the benefits, primarily in producing results without the use, or with less use, of debilitating drug or other therapies, behaviour modification therapy remains in use today, but not without its critics. References Bandura, A. & Walters, R. (1963). Social Learning and Personality Development. New York: Holt, Rinehart & Winston. Bandura, A. (1969). Principles of Behavior Modification. New York: Holt, Rinehart & Winston. Bandura, A. (1973). Aggression: A Social Learning Analysis. Englewood Cliffs, NJ: Prentice-Hall. Bandura, A. (1977). Social Learning Theory. New York: General Learning Press. Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W.H. Freeman. Belsky, J. (2002). “Developmental Origins of Attachment Styles.” Attachment & Human Development. 4:2:166-170. Blewitt, J.; Lewis, J. & Tunstill J. (January 2007). “The Changing Roles and Tasks of Social Work.” Social Care Institute for Excellence. Blumer, Herbert. (1969). Symbolic Interactionism: Perspective and Method. Englewood Cliffs, NJ: Prentice-Hall. Contrada, J.D. (9 September 2004). “Consider behavioural therapy before medication for AD/HD kids, UB psychologist says.” UB Reporter. University at Buffalo: Vol. 36, N. 2. Available 11 April 2007 from Cote, R.W. (1973). “Behaviour Modification: Some Questions.” The Elementary School Journal. Vol. 74, N. 1, 44-47. Coulshed, V. & Orme, J. (1998). Social Work Practice –An Introduction. Basingstocke, Palgrave. Halmos, P. (1965). The Faith of the Counsellors. London, Constable. Howe, D. (1987). An Introduction to Social Work Theory. Aldershot: Ashgate. Hutchison, E. D. (2003). Dimensions of Human Behaviour. (2nd Ed). London: Sage. Mather, N. & Goldstein, S. (2001). “Behavior modification in the classroom.” Learning Disabilities and Challenging Behaviors: A Guide to Intervention and Classroom Management. 96-117. Macdonald, G. & Turner, W. (2005). “An Experiment in Helping Foster-Carers Manage Challenging Behaviour.” British Journal of Social Work. Vol. 35, 1265-1282. McCrea, Ron. (1975). “Thinking About Behaviour Mod: A Road Map Through Never-Never Land.” The Capital Times. Alice Patterson Foundation. Available 11 April 2007 from Miller, N. & Dollard, J. (1941). Social Learning and Imitation. New Haven, NJ: Yale University Press. Munro, E. (2004). “The Impact of audit on social work practice.” British Journal of Social Work. Vol. 34, pp. 1077-1097. Payne, M. (2005). Modern Social Work Theory. Basingstoke: Palgrave. Sheldon, B. (1982). Behaviour Modification. London: Tavistock Publications Ltd. Sudbery, J. (2002). “Key Features of Therapeutic Social Work: The Use of Relationship.” Journal of Social Work Practice. Vol. 16, N. 2, 149-162. Weathers, Lawrence. (2007). “Behaviour Modification.” ADHD: A Path to Success. Available 7 April 2007 from Zimrim, H. (1984). “Do Nothing but Do Something: the Effect of Human Contact with the Parent on Abusive Behaviour.” British Journal of Social Work. Vol. 14, 475-485. Read More