TOWARD A CONSTRUCTIONAL APPROACH TO SOCIAL PROBLEMS: ETHICAL AND CONSTITUTIONAL ISSUES RAISED BY APPLIED BEHAVIOR ANALYSIS

THE CONSTRUCTIONAL AND PATHOLOGICAL ORIENTATIONS

The present section will compare two orientations toward treatment which, I believe, can profitably be applied to present practice and research. I hope thereby to make explicit certain assumptions and procedures whose present implicitness creates problems in comparison and analysis. The term for one of the orientations is a new one. In the section thereafter, I shall present a model which derives from this orientation and is thoroughly consistent with (a) the constitutional requirements of mutual contracting and limitation of power, (b) other ethical obligations which the Constitution exemplifies, (c) the therapeutic needs of the patient (or other consumer), and (d) the investigative and analytic requirements of behavior analysis. As a matter of fact, by using this model the needs of the investigator and client can best be met through meeting constitutional requirements and ethical obligations. The more general orientation, into which the specific model fits, is shared by many other approaches and models and is not exclusive to it. I believe the presentation may make explicit a direction toward which the field has been moving. Hopefully, it will hasten the process.

The orientation to be proposed is a constructional one. This is defined as an orientation whose solution to problems is the construction of repertoires (or their reinstatement or transfer to new situations) rather than the elimination of repertoires. Help is often sought because of the distress or suffering that certain repertoires, or their absence, entail. The prevalent approach at present focuses on the alleviation or the elimination of the distress through a variety of means which can include chemotherapy, psychotherapy, or behavior therapy. I shall designate these approaches as pathologically oriented (pathos, Greek, suffering, feeling). Such approaches often consider the problem in terms of a pathology which-regardless of how it was established, or developed, or is maintained-is to be eliminated. Presented with the same problem of distress and suffering, one can orient in a different direction. The focus here is on the production of desirables through means which directly increase available options or extend social repertoires, rather than indirectly doing so as a by-product of an eliminative procedure. Such approaches are constructionally oriented; they build repertoires.

The fact that the outcomes are described differently is not simply a matter of verbal redefinition. The differences that can result become clearest when considered in terms of the four elements of a program, previously noted.

1. Outcomes or targets: - Although similar outcomes may be produced by the two orientations when viewed in terms of distress alleviated, the outcomes of the two approaches are not necessarily similar when viewed in terms of repertoires established. For example, in a series of treatment sessions one can progressively decrease stuttering and thereby increase the ratio of fluent words to total utterances. One can also progressively instate and extend a specific fluency pattern which consists of well-junctured speech and thereby increase the ratio of fluent words to total (and decrease stuttering). Viewed in terms of elimination of stuttering or increase in fluency (the alternate statements can simply be verbal redefinition), the outcomes may be similar. However, viewed in terms of patterns established, the outcomes may be quite different. And the training procedures and other program elements must also differ. This raises questions about outcome comparison.