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

There are, of course, contingencies other than those given, but one effect of focusing on the larger set of problems to eliminate has been the slowed pace of development of intervention procedures and formulations relevant to obtaining satisfaction. It is impressive to note the contrast found in patient work-ups between the extensive and detailed reporting of present illness and its history and the skimpy and global suggestions for treatment. Indeed, the contrast found in the professional's report often very accurately reflects an identical contrast in the patient's self-report. This will be long on affliction and short and succinct on treatment (You help me). The parallelism in the two reports is not accidental. Nor is it derived solely from mutual manipulation based on the current identification of the helping mental health professions with the elimination of pathology. For the patient, since presentation of pathology is a necessary condition for admission, he will therefore so present himself; for the therapist, since treatment of pathology is his repertoire, he will therefore solicit and shape it. These operants undoubtedly enter on many occasions, but other contingencies may contribute to the continual recurrence of this parallel.

One strength of the parallel derives from the fact that it is found not only between professional's presentation of patient and patient's presentation of self, but also between patient's seeking help from others and patient's seeking help from self. Stated otherwise, the patient does not come for treatment when things are going well not simply because he then lacks the ticket for admission, so to speak, as might be inferred from a simple operant analysis, but for the same reason that he will typically not bother to analyze what is going on in his own life when things are going well, either. It may be argued that it is human nature to define problems only when things are going wrong, that is, when the crisis is upon us. This observation can be explained in more mundane contingency terms, namely, that when things are described as going right, certain referent behavior-reinforcement contingencies are in effect. Analysis of these is not only costly on its own, but by displacing the referent behaviors, it thereby disrupts their contingencies. Accordingly, the doubly costly behavior of analysis is typically assumed only when the referent contingencies change so that the referent behaviors or consequences become excessively costly. Stated in common language, the patient is hurting. He may then take time to analyze and reflect, but characteristically, what he will then reflect on is what went wrong, and what and how it should be avoided or eliminated. The likelihood of constructional solution is then remote. In parallel manner, it can be shown that the patient will seek outside help under similar conditions, often after repeated failure of self-analysis of the type reported.

Accordingly, the consumer of the remedial service as well as the delivery agent may both focus on the distress involved and its alleviation. The patient seeks help because things are going wrong and the therapist is a member of a helping profession. More than the mutual shaping described earlier goes on: both are governed by similar ideologies. The personal history of the consumer as well as the professional history of the delivery agent may then become the observation of problems viewed as distressful or cases in distress, of ways in which things have gone wrong, of cries for help which went unheeded, of the often arduous and dubiously successful nature of the remedial undertaking. With Muller (1953) they can conclude that "the tragic sense is the profoundest sense of our common humanity," and that our acceptance of this sense provides the hope that we might thereby "be freed from the vanity of grandiose hopes as of petty concerns. We might learn that 'ripeness is all,' and that is enough" (p. 374).