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

I believe we should move toward the guidelines suggested in the discussion of institutional repertoires of reinforcement, when the spiral metaphor was employed. First, we should carefully analyze that spiral (or cycle) to ascertain that the intervention point should be the reinforcers already provided by the staff. If this seems recommended, it is these reinforcers which might be exchangeable for tokens, which are delivered contingent on more desirable behavior. The staff has already demonstrated its effectiveness in the use of these reinforcers. Why then bother with tokens? Why not use these reinforcers themselves? An answer may be that it is the timing of delivery which is inconvenient to the staff. Accordingly, a token delivered to a patient at a time he requests it (by the more desirable behavior) may be exchanged for attention by the staff when they have the time available. Another use may be the present existence of complex reinforcers which can not readily be delivered (for example, a job on the grounds at union pay). The tokens might then be used as reinforcers to maintain program progression (a training course, in this case) toward this contracted outcome.

The effective use of tokens in the institutionally defined spiral is not defined as therapeutic, nor is any other training system with such objectives so defined. It does not follow that because an institution is effective in shaping certain institutionalized behaviors, and that because this effectiveness can be used to shape more desirable behaviors (in accord with outcomes contracted, with the patient), that such outcomes are necessarily congruent with those which might be addressed to contingencies in the world outside. Such programing may require explicit orientation in this direction. Institutional programs which are otherwise directed may be defined as custodial, that is, they make possible an amenable existence within the institution while the patient (or prisoner) is in its custody. They should also follow the medical edict of not harming the patient or deteriorating him. They fulfill that part of the social contract relevant to treatment of subjects within the institution to which society has assigned their custody. It should be evident that the custodial designation is not intended disparagingly. The smell of incontinent patients, for example, often imposes undue burdens on any staff members who wish to work with them. A program which establishes continence is a necessary custodial program (Foxx and Azrin, 1973).

The referent system in the therapeutic social contract may be the family, or other such unit. Analysis of the spiral for family-patient relations would follow the model already suggested for analysis of the institution-patient spiral. The family would be brought in to consider how the family-patient spiral effectively shaped the disrupting patterns at issue. That spiral should be analyzed to ascertain that the intervention point should be the reinforcers already provided by the family, and so on (see institutional paragraph).