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

In the present section, I shall indicate how we have applied the constructional model described to one particular setting, namely our own service-research unit and its requirements. These requirements may differ for other units. Accordingly, the particular instruments I shall discuss are not presented for their universal applicability, but rather as illustrations of how one application of the constructional model meets constitutional and ethical requirements. Hopefully, it may spur planning along these lines elsewhere.

The instruments to be described derive from the requirements of a university system of hospitals and clinics35 with a strong research reputation, both basic and applied. The institution has therefore, in many areas, pioneered new methods of successful intervention for patients and trained other professionals. In the process of providing such services, we have attempted to be continually explicit about the repertoires we were applying, the repertoires the patients were applying, the patients' relation to the resources available to them in their more typical ecology, what changes were required, and the functional relations between these. The research purpose is evident, but I regard these as fulfilling therapeutic requirements as well. If the patient can use a similar research approach, he may better assess the contingencies of his life-and teach us. Our research aim is furthered. We both hope to gain insight into the contingencies which govern his repertoires, how to change the contingencies, and how to assess them. Special instruments had to be developed for these purposes. Their development and assessment were governed by the constructional rationale described in the preceding section.

The Constructional Questionnaire: - The initial interview after acceptance to our services is guided by a questionnaire developed to obtain data for each of the four program elements described: targets, current relevant repertoires, change procedures (often strategy at this stage), and available and potential supports or reinforcers for maintenance through the program and thereafter. The questionnaire is presented in the appendix to eliminate the digression necessary to describe it in detail. My focus in using the questionnaire is on ascertaining the critical reinforcer, namely, what the patient is after, which I regard as presently pertinent for three reasons.

First, if we can find out what the patient is after, and if we agree to help get it (we need not agree; this will be elaborated in the discussion of contracts), progression toward this goal will serve as the program reinforcer. Extrinsic reinforcement in the form of tokens, points, etc., is then not necessary, and concentration can be on mutually agreed-upon goals, the means for whose attainment can be as clearly relevant to the social contract as are the ends. The progression requires record-keeping vital to (both) our interests. The patient may then readily assent to other requirements we both agree on. Renegotiation is expected, and coercion is absent.