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

Third, history is important, but the history is of operants which have been shaped or otherwise developed. These obtain reinforcing consequences otherwise not available. A stutterer, for example, traced the background of his pattern to the stress he suffered during childhood; his parents were increasingly at each other's throats, and their marriage broke up when he was seven. Specific onset was at five, when there was a dinner guest who stuttered. He recalled intentionally imitating the dinner guest. He discovered one day that the pattern controlled his speech-it was now involuntary. "What did your mother do when you started stuttering?""She was beside herself with fury." One can argue tel père, tel fils, or, on the other hand, visualize a period when his parents' attention is turned on each other, and withdrawn from him. The dinner guest is obviously listened to by the parents. The child imitates. Initial smiles are replaced, as the pattern progresses, by the full attention accompanying fury. This is not an ideal way to deliver attention, nor an ideal way to obtain it, but given the deprivation and circumstances, they serve. Data supporting interpretation of his pattern as an operant can be obtained from his history, discussed with him, and used to analyze and change the current contingencies of which his (expensive) pattern is a part in his speaking ecology (the laboratory program proceeds somewhat differently). Accordingly, the history of the operants is interwoven into the work-up.

Change procedures follow the initial statement. The tentative outcomes, stated explicitly, introduce the possible program. For the librarian, the outcomes might involve an explicit reordering of priorities. Learning how to turn down or defer low-order requests is a way which maintains the good relations she values (teaching her to turn things down in a way less costly than her symptom), as is revising her work arrangements so that she can do her work while on the job.

The remaining sections of the work-up follow the p.i. outline discussed in the model.

In some cases, one can present this work-up to the patient for his approval: Is this what you would like to see entered into your record? Do you have any objections or changes ? In one recent case, the patient had the write-up duplicated and presented it to his friends when they asked why he was seeing a shrink.41

Compared to the ease with which we can develop a coherent account using the more conventional pathologically-oriented work-up, we find that this task is often difficult and time-consuming.

The Contract: - The write-up forms the basis for a contract between patient and therapist. It suggests to the therapist what goals he might offer as possibilities. The patient may have other ideas, in which case negotiations may ensue. In all events, eventually a contract will be developed. The contract can be explicit, either written or verbal, or implicit, but the same rationale applies in all cases. Presented in the appendix is a form for a written contract to be negotiated between patient and programer. This lists the outcomes toward which the program is directed. Their establishment constitutes satisfactory termination of the sessions. It also lists other requirements. Contracts may be renegotiated upon call. I shall confine my discussion to two issues related to constitutional and ethical issues.