My case study below highlights a behaviour difficulty that can be analysed and changed by applying the behaviour principles.
I was keyworking a non-verbal autistic client in a residential home who suffered from agoraphobia for over 5 years. He had been assaulted by a member of the public while out in the community. He had become very frightened of going out. Staffs noticed he would experience panic and anxiety attack whenever prompted to go out in the community and an escalation of aggressive behaviour towards them. This caused staff to abandon trying to support him deal with his phobia.
With little knowledge on behavioural intervention and modification I encountered a dilemma in advocating for the client as bound by my duty of care while, on the other hand the need to ensure staff health and safety is not jeopardised as staff felt unsafe to engage with the client due to his aggressiveness. Other conflicts involved for example staff little knowledge on agoraphobia, beliefs ‘he can never change’ and ‘he is helpless’ according to some members of staff and communication difficulties due to the client disability. Also doubts on whether the client did want to access the community as on several occasions when asked he had given inconsistent answers. And was it staff inputting their values on him in that case oppressing and disrespecting him as an individual worth of making choices. In hindsight I should have involved a multi-disciplinary team of psychologist, psychiatrist, social worker and occupational therapist in carrying out an assessment, which may have applied the learning theories as analysed below.
Classical conditioning learning occurs when there is an association of “conditioned and unconditioned stimulus” (Milner and O’ Byrne, 1998. p.112) such that the former evokes a response previously evoked only by the later like in the famous ‘Dog-Salivation-Experiment’ by Pavlov (1911). If applied in this case study it would first try to identify the original stimulus in this case (the client accessing the community and being assaulted), the response (the client having panic attack and being aggressive towards staff) and the associated stimulus (staff prompting the client). It may then suggested that the client has associated accessing the community with being assaulted while the panic attack and aggressiveness towards staff this association has aroused, would be paired with the prompts from staff. Working or assessing this client would involve the development of “hierarchy of responses” (Milner and O’ Byrne, 1998. p.113), which involves a step-by-step counter conditioning “systematic desensitisation” (Coulshed and Orme, 1998. p.156) of the less feared situations to the most feared ones through relaxation techniques and support.
In contrast, operant conditioning claims that learning occurs when voluntary behaviour arises from an individual and becomes more or less likely to be repeated depending on its consequences as demonstrated by Skinner (1953) in his ‘Skinner-Box-Experiments’ with a cat and a pigeon. My case study above involves a client with anxiety which Milner and O’Byrne (1998) argues “ABC Approach” (Milner and O’ Byrne, 1998. p.114) is necessary in identifying and analysing the behaviour that needs modification in agreement with the client. This would involve establishing the Antecedent (staff prompts to the client), Behaviour (panic attack-aggressiveness) and the Consequences (client doesn’t get to go out in the community and staff are reluctant to support him deal with his phobia). The consequences will either “strengthen or weaken behaviour by reinforcement or punishment” (Payne, 1997. p. 114). This model further suggests that people learn to behave by the value they place on the consequences of that behaviour, so it might propose that not going out is the desirable consequences (reward) for this client and is much stronger than the punishment (staff reluctant to support him deal with his phobia). Therefore, the client will likely continue acting in this way as staff responses are negatively reinforcing his behaviour and other support may be necessary for example motivation, changing staff response and also the reward.
Proponents of behaviourism models argue that they are advantageous due to their ease adaptability and practicability by inexperienced practitioners without extensive training as would be expected of a “psychodynamic approach” (Adams, R, Dominelli, L and Payne, M, 2002. p. 144) in facilitating an effective outcome. Payne (1997) also argues that the prescribed “explicit, structured guidance…and assessment instruments employed” (Payne, 1997. p. 134) gives unskilled practitioners the confidence to apply behavioural theory and procedures in interventions. I would also argue that as behavioural intervention focuses on the negatively learned self-defeating behaviour it offers and engages the client in an anti-oppressive and accepting manner by treating them as the expert in choosing which behaviour requires modification. However, some social work practitioners have criticised behavioural approach as being “excessively mechanistic” (Banks, 2001. p.73) and “non-human” (Payne, 1997. p.122) in some of its methods, conducts and terms used, as they conflict with client individuality and will to choose. Critics also argue that due to this theory focus on objectively observable behaviour, it disregards the activities of the mind and does not account or explain all kinds of learning for example the “recognition of new language patterns by young children”(http://www.funderstanding.com/learning_theory_how.html)[13:03:05] as in this situation no reinforcement mechanism is present. Another criticism of this approach is on its overall intervention emphases on the need to change or modify the client behaviour rather than those around the client who may be the problem, which Milner and O’Byrne (1998) argues that social workers tends to do as they find “easier to change an individual than challenge the status quo” (Milner and O’Byrne, 1998. p.129).
On values, behavioural approach engages the client in partnership to identify the behaviour that needs modification. In so doing the practitioner respects and acknowledges the client individuality and ability to change through the choices the client makes as stipulated by CCETSW (1995) on the need for the worker to “engage the client in partnership” (CCETSW, 1995. p.10-15). The role of the practitioner in behavioural modification is to facilitate and support the client. This enables the client to be in control and own the process and work with it at his or her own pace. Therefore the practitioner creates a feeling of empowerment and self-determination and this prevents labelling or making judgement on the individual but rather on their behaviour. I would also argue that where the client has positively embraced change it enables both the practitioner and the client to develop a trustful, warm and genuine relationship. In that sense the worker will have practiced in a “honest, trustworthy, reliable” (CCETSW, 1995. p.18) manner.
In conclusion, behavioural intervention is effective if properly applied with the client consent and participation to modify undesirable behaviour. As it is honest, transparent, accountable and open to scrutiny because its based on what is observable and measurable which reduces the likelihood of abuse. Also it presents its aims, objectives and means of achieving them, which is empowering to a client and promotes their choice as they can choose not to take part in the process with minimal impact on both service user and staff.
This approach can also be used on its own, as can some of the other theories, but if eclectically applied in a social work context they can provide a more powerful critical analysis of the client problems and the environment around them.
References:
Adams, R., Dominelli, L. and Payne, M. (2002). Themes, Issues and Critical Debates, 2nd ed. Basingstoke, Hampshire: Palgrave Publishers.
Banks, S. (2001). Ethics and Values in Social Work. 2nd ed. Basingstoke, Hampshire: Palgrave Publishers.
Behavioural Social Work Group (BSWG).(1998). Equal opportunities and anti-discriminatory practices. [Online]. England: BSWG. Available from:
http://www.funderstanding.com/learning_theory_how.html[Accessed 13:03:05]
Central Council for Education and Training in Social Work (CCETSW). (1995). Assuring Quality in the Diploma in Social Work – 1: Rules and Requirements for the Diploma in Social Work. London: CCETSW.
Coulshed, V. and Orme, J. (1998). Social Work Practice: An Introduction, 3rd ed. Basingstoke, Hampshire: Palgrave Publishers.
Feltham, C. (1995). What is Counselling?. London: Sage Publishers, p.83. Cited in: Adams, R., Dominelli, L. and Payne, M. (2002). Themes, Issues and Critical Debates, 2nd ed. Basingstoke, Hampshire: Palgrave, p. 144.
Milner, J. and O’Byrne, P. (1998). Assessment in Social Work. Basingstoke, Hampshire: MacMillan Press Publishers.
Payne, M. (1997). Modern Social Work Theory. 2nd ed. Basingstoke, Hampshire: Palgrave Publishers.
Sheldon, B. (1995) Cognitive-behavioural Therapy: Research, Practice and Philosophy. London: Routledge Publishers.
