The use of behaviour modification in residential care is increasing, and so the recent publication of yet another book on the subject: Martin Herbert, The Behavioural Treatment of Problem Children: A Practice Manual1, seemed to provide a useful focus for examining some of the issues raised by behaviour modification as a framework for practice and its techniques for intervention.
The book is attractively presented: the substantial amount of information offered is liberally peppered with flow charts and diagrammatic summaries. Stages in the process of intervention are illustrated by 20 numbered steps which stand out clearly from the text in their shaded boxes. The fact that steps one to 15 cover introductions, (e.g., Step 1: explain yourself), data collection, and assessment, whilst steps 16 to 20 cover planning, implementing, terminating and evaluating the treatment programme, does, however, suggest an over-emphasis on diagnosis. Despite this criticism, the section on intervention is a useful one for the practitioner.
The application of behaviour modification techniques in residential care are all too often restricted to the use of token economy regimes. This publication, however, offers brief descriptions and instructions for the implementation of a number of procedures including: modelling; social skills training; role play; time out; extinction; cueing; prompting; and punishment, as well as positive, negative and differential reinforcement.
These and other “jargon” terms used in social learning theory are explained concisely. This practice manual sets out to present the acceptable face of behaviour modification: “Rigorous thinking and scientific assessment are not meant to be at the expense of clinical art and sensitivity” and indeed step 16b “Treatment plan" advises the worker: “Take into account relationship and other non-specific therapeutic factors" ... Among these non-specific factors are the therapeutic relationship, the client’s expectations of being helped, the attributes of the therapist and the treatment setting.
As well as admitting not only the existence, but the importance of relationship, Martin Herbert also tackles, albeit briefly, some of the criticisms generally made on ethical grounds of behavioural approaches, by offering practical guidelines on ethical issues:
Obtain the full informed consent of the client or those responsible for him.
Ensure that the client’s participation in the programme is voluntary.
Give the client the clear option of withdrawing from the programme if he so wishes.
Make sure that the client and/or other persons of significance to the client ... are engaged in the selection of treatment objectives.
Give decided preference to positive treatment procedures over methods with aversive connotations.”
This publication deserves consideration by social work practitioners in the residential setting if only because its emphasis on process has a much wider application in residential work than the behavioural approaches on which it concentrates. It also illustrates clearly some of the attractions of a behaviour modification approach.
A behaviour modification approach requires as a first step the analysis of observed behaviour and the selection of certain targets for intervention. The problem is specified and therefore appears to be more manageable to both worker and client. The emphasis on obtaining hard data for assessment, and the availability of a number of clearly identified techniques for intervention along with planned termination and evaluation, stand in stark contrast to the subjectivity of many assessments, poor or non-existent treatment plans, and vague use of relationship or environment planning.
These advantages of a behaviour modification approach should not be dismissed lightly, but the case against it seems to me to be far stronger than that in its support. The specificity of intervention may well involve over-simplification as a result of uni-causal definitions of the problem.
It has the disadvantage that it is as individually-focused as many of the psychodynamic therapies, so that for example, in the case of the treatment of delinquents it can be argued that behavioural approaches treat only the symptoms and not the real cause which may lie beyond the individual delinquent in the family, neighbourhood and society to which he belongs.
The use of behaviour modification with juvenile delinquents in secure accommodation has a particularly sinister potential. In these settings token economy regimes are often the form of intervention used. While not questioning the integrity and humanity of those who currently enforce such regimes, and who work with very difficult young people, we should question whether all aspects of waking life can justifiably be subjected to continual assessment and reinforcement in this way.
A further complication in this setting is making a meaningful distinction between the modification of behaviour for desired individual change, and that for institutional control.
The use of behavioural techniques raises issues about client consent to treatment. How far the client understands the treatment process might depend on how far the practitioner follows guidelines on ethical issues. Even so, the fact remains that the client has less control, less choice and less participation in treatment than in some other forms of intervention.
Another objection is to the claim behaviourists advance that their methods encourage consistency of response in the worker. The ability to accept, and as far as possible understand inconsistency of human behaviour in ourselves and others is an important social skill. To create unrealistic consistency in the residential setting is to create an impossible gap between treatment goals and rehabilitation goals. How dull and unrealistic life would be if we were all consistent.
Because some forms of social work are about intervening in social situations (people’s lives) and creating change, then most methods of intervention can be open to criticism on some count. It seems to me, though, that behaviour modification is open to much criticism and that a valid case for its use in the residential setting still remains to be made.
(1) Herbert, M., The Behavioural Treatment of Problem Children: A Practice Manual. London; Academic Press, 1981
This feature: Elliot, D. (1981). The Unacceptable Face of Behaviourism. Social Work Today 12 (48)