The process of clinical behavior analysis: From the general to the specific.

Abstract

Joe Cautilli (1999-2000) described the Clinical Behavior Analysis (CBA) SIG at ABA as devoted to the study of comprehensive behavior analytic adult outpatient treatments (pg. 2), which meshes nicely with my professional objectives as a psychologist. As a private practitioner, I operate in a context that does afford me opportunities to influence client repertoires outside of the box. And the box is typically one forty-five minute session weekly. Abolishing operations, establishing operations, stimulus control, derived relational responding, and reinforcement are general processes that describe behavior-environment relationships and how they pattern over time. However, the stimuli that are relevant or give meaning (DeGrandpre, 2000) to any one person are particular to that individual, and when we are referring to verbally competent adult outpatients, delineating their histories of these processes can become very bewildering indeed. CBA's unique contribution is the thoroughgoing explanation of these phenomena from a functional perspective, thus enabling practitioners to situate the specific particulars into their proper place. It suggests which should be manipulated and with what technique. My belief is that if I am truly working from a functional perspective, I cannot rely on a predetermined set of techniques only. Of course, Beck's cognitive therapy is very likely to be effective for depression, as exposure with response prevention is likely to be effective with obsessive-compulsive disorder, etc. The advantage of CBA is that it allows for the meaningful augmentation of these interventions, taking into account the so-called therapeutic variables that influence treatment outcome. In my private practice it seems that these nonspecific phenomena are quite common, and I want to get a handle on them. Sorting this all out is why I return to ABA every year. The organization, and in particular those individuals who are CBA affiliated, are my professional verbal community. However, when the convention is over, I return to a private practice setting that is a different sort of verbal community, one that is unfamiliar with a natural science approach to traditional psychological issues. Certainly, discourse with psychologists from other orientations is as rich and valuable as any other professional experience. However, I have ongoing private dialogues that translate these discussions into behavior analytic terminology. The language, concepts, and philosophy of CBA allow me to make sense of my experience with clients. There are a wide variety of presentations at ABA that are relevant to CBA in the basic, applied and theoretical domains. There have also been several in the applied domain that have illuminated the process of therapist-client interactions in a unique manner, that is, in a case study format. Lucianne Hackbert has presented at least twice in the past few years, and Chauncey Parker did likewise this past May. These presentations were significant because they enabled me to perceive stimulus control and reinforcement only as abstract concepts that help consolidate a worldview, but also as fully lived processes that are tangible in an interpersonal context. The clinician is a major source of reinforcement, stimulus control, and establishing operations when she asks about a client's desperation resulting from panic attacks in the middle of the night, his sense of a failure, losing control and not being a man, or when she encourages the client to deliteralize language functions, or when she assists him with identifying the negative cognitive triads related to depression. Likewise, the client is a source of reinforcement, stimulus control and establishing operations relative to the clinician, whether it's in adult outpatient therapy or any other type of therapeutic social interaction. These processes are just in the relationship, they are the relationship. …