Informal construction of contingencies in family-based interventions for oppositional defiant behavior.

Abstract

Clinical Behavior Analysis (CBA) and Applied Behavior Analysis (ABA) are distinguished by target-population and technology. Two brief case-reports illustrate how CBA can be relevant for a problem-category that is typically associated with ABA, and to document the fluid borders between the two approaches. In both cases improved parental behavior was shaped and maintained through sources of reinforcement under control of the child in the family's natural environment. A concern with the pitfalls of instructional control and functional implications of interpersonal relations are highlighted as well as the reliance on naturalistic observation of the family and its interaction with the therapist (therapeutic relationship) during the sessions as a unit of analysis. Analog functional analysis guided the construction of treatment in the first case, while the parent's discussions with the therapist guided the second. Both therapies produced parental mediator behavior parallel to improvement of the child's target-behavior. In both cases changes in parental behavior and in child-behavior interlocked in the construction of new interpersonal contingencies at home. Key words: Clinical Behavior Analysis; Instructional Control; Naturalistic Environment; Interpersonal Contingencies. ********** Applied Behavior Analysis (ABA) is traditionally identified with practices of direct contingency management guided by functional analysis under controlled experimental conditions, while Clinical Behavior Analysis (CBA) refers to the application of contextual behaviorism to outpatient talk-therapy in outpatient settings, with an emphasis on rule-governance, language and interpersonal relations (Dougher and Hayes, 2000; Kohlenberg, Bolling, Kanter and Parker, 2003). Oppositional and aggressive children (whether verbally capable or not) are a traditional subject-group for ABA, even when the analyst personally has no control over the relevant environment. From its early days on, ABA adapted itself well to this challenge, by training parents to directly manage relevant contingencies at home, enlisting them as actual behavior engineers (e.g. Wahler, Winkel, Peterson and Morrison, 1965). Similar strategies are difficult to imagine for instance with the typical adult outpatient who suffers from an anxiety disorder or interpersonal distress. One of the features that is said to distinguish CBA is that it targets exactly the latter population: verbally capable clients whose daily life contingencies the therapist cannot directly control. The focus of CBA on adult outpatients suggest that behavior analytic treatment of children's problems should only interest ABA, a claim that is not in dissonance with most of the relevant literature. The present article pretends to illustrate that treatment of children's problems in a nonresearch setting can have more or less of the above mentioned features that define CBA. Two cases are shortly discussed to bring to the foreground the fuzzy boundary between applied and clinical behavior analysis in work with families that seek help for child behavior problems. Case one: Jenny was a developmentally normal three year old, only child of a young couple that sought guidance at an outpatient clinic concerning the handling of her tantrums which according to them had always existed: the child had bouts of crying until turning blue when it was only a few months old, had bitten its mother frequently, and generally interacted in coercive ways until the present day. Weekly sessions happened at the clinic with the entire family. In the first interview, both parents expressed intense despair, about their inability to control their child's behavior and the severe social exclusion they had fallen victim to in their village because of this. They reported having seen several physicians whose advices they had followed without result, that two types of prescribed medication had provoked paradoxical effects and that a one year long psychological treatment had brought no relief. …