About the Skills
CognitiveBehaviorManagement.com owes its existence to a concern about the lack of skills in human services (education, clinical, correction and protective) in dealing with children whose behavior IS the problem. These children attain labels of delinquency, dependency or diagnosis, but receive little help because of the failure of the prevention/intervention technology used in the systems designed to provide help. There is a fifty year history of such failure well documented through national reports starting with the Hobbs Report in 1953, and continuing through the Joint Commission of Mental Health of Children , the President’s Commission on Mental Health , the Office of Technology Assessment , the Institute of Medicine , and the House Select Committee on Children, Youth and Families , and concluding with the President’s New Freedom Commission report: Achieving the Promise: Transforming Mental Health Care in America – July 22, 2003. All of these reports concluded that services to children were inadequate and ineffective, but none identified the failed technology as the reason for that failure. The recommendation is always the need to do more of what is being done: e.g., more money.
CognitiveBehaviorManagement.com believes that the biomedical, psychodynamic foundation of most human service programs is a failed philosophy and technology which has never had any scientific evidence based support. Cognitive behavior approaches, on the other hand, are specifically evidence based and scientific.
Cognitive Behavior ManagementSM is a process in which distressing thoughts are reconsidered, new meanings are found, and change is made through habituation and reinforcement. In many Cognitive Behavior ManagementSM interventions, learning the concepts required to utilize the skill is a significant part of the process. This introduction is a psycho-educational process which will shape the concepts necessary for understanding Cognitive Behavior ManagementSM.
If Operant Behavior Management is stimulus – response, Cognitive Behavior ManagementSM is stimulus – thought/emotion – response. Thought/emotion is tied in this manner since emotion is a value added to a thought based on the thought’s utility. The definition by the nineteenth-century utilitarian, Jeremy Bentham is that utility is the pursuit of pleasure or the avoidance of pain. Thus, a thought which has meaning to the individual contains some measure of pleasure and/or pain which equates to an emotion. The degree of emotional content derives from a comparison with past experiences.
Note, that emotion is not the same as ‘feeling’, which is a message from the senses – or sensation. Feeling in this context is the actual bodily change that is caused by a stimulus, which is then interpreted by a thought, which produces the emotion. If I stick you with a pin, this stimulus is likely to cause a ‘sting’, which you might interpret as pain. The pain, in turn, may be interpreted as caused by me, generating the emotion of ‘anger’ toward me because of the belief that I trespassed on your space and caused harm. Or you may experience ‘fear’ because you believe that I will hurt you again. What you felt – the stinging sensation is the ‘feeling’, and the way you interpreted it is the emotion.
In fact, you may not even feel the sting, if your energies are being used elsewhere. How often, have you gotten a ‘paper cut’ and not felt the pain until you discovered you were bleeding. ‘Feelings’ are always biological while emotions are always biographical. You will find authors will, however, habitually use these terms interchangeable, and the reader is cautioned to always remember to identify the context if s/he expects to understand the intent of the word. While the facts may be clear, language is notoriously ambiguous.
A stimulus can alternatively:
- Not contain any information and therefore not arouse the individual at all,
- Contain information and cause arousal which leads to an interpretation which may or may not contain an emotion,
- Contain information that is interpreted based on past experiences as intensely felt.
Gregory Bateson, as the ‘difference that makes a difference’, as used here, precisely defines information. If the difference is not sufficiently strong to make a difference, there is no information. In the first situation, the person may not even be consciously aware that the stimulus occurred [as in our example of the paper cut]. In the second case, the person may respond quite casually. In the third, the person may respond quite strongly.
We must point out that having an emotion is not necessarily a bad thing. Emotions motivate us to do something, and normally this is a good thing. The third case above holds some potential for distressing emotions and the resulting behavior. Such distress, may also cause difficulty with others, but this is only so when the person’s ‘inner logic’ [their pattern formation of prior experiences’] is ‘out of kilter’ with the norm of the people with whom they associate. If the distress and ensuing behavior are well understood by the others, empathy and comfort are likely outcomes.
However, if the distress is not understandable, the person’s behavior is likely to be considered to be bizarre. If, for example, you believed from prior experience that people were out to get you, you may respond quite dramatically different to a person who runs into you. If others around you do not have this belief, they are unlikely to understand the intensity of your response. It is this ‘inner logic’ which sets the context for the outer events and the emotional content that sets the tone. This is often seen in ‘spy’ movies, where the actor is responding out of inner knowledge in apparently bizarre ways.
The ‘inner logic’ is built up over time and experience and the interpretation, patterning and generalization of many, many experiences. The ‘inner logic’ may not be ‘true’, in the sense that it is what everyone would make of the situation. It is, however, the ‘reality’ of the individual. The failure of strict behaviorism is the failure to take into account the inner logic of the person who is responding in the disruptive fashion. The inner logic of Yeshua ben Yosip [known commonly as Jesus Christ] was quite different than, say, Charles Manson. Therefore, the two would likely act substantively different to ‘a slap on the cheek’.
The pattern formation which creates the ‘inner logic’ is primarily developed over the first seven years of life from random events. It is up to the infant child to ‘make sense’ of the world through identifying patterns of experiences and ‘generalizing’ them into categories. It is important to note that the first three years of the child’s life, the child‘s ‘thinking’ is dominated by the right brain, which does not generally deal with language. Therefore, the child is creating an ‘inner symbolism’ which s/he cannot describe. The fourth, fifth and sixth years of life, is a process of left-brain development, but apparently it is only after the seventh year that the left-brain becomes dominant. The early pattern formation is therefore dominated by symbolic thinking which the person cannot talk about, even if s/he wanted to. We don’t what our symbols or metaphors mean or they would be put into words. But this does not indicate that such symbols are without meaning.
Cognitive Process Correction [generally related to the Cognitive Therapy of Beck and the Rational Emotive Therapy of Ellis] is predominantly a left-brain exercise with a five step process of 1) awareness, 2) attendance, 3) analysis, 4) alternatives and 5) adaptation. To deal with the ‘inner symbolism’, the use of imagery is vital. For children who have been invalidated and whose early schema is maladaptive, this creates a context for an inner logic that the person cannot even understand, in the sense of being able to articulate, although they know it has powerful meaning. Schema or the plural schemata, are organizing attractors in the mind. When operating, they draw all of the necessary thoughts, emotions and value regarding a given domain together into a context. This is not unlike the rock in the stream that draws the water into an ever changing, but always similar pattern. If the schema is an attractor, the experiences will always be different, but will always be similar. As a result, many people with severe and persistent problems in living seem to relive the trauma with different people at different times.
While there are schema concerning conventions, such as how to operate in a restaurant, personal schema, such as those beliefs about self and others are of major psychological concern. If such schemata are maladaptive, imagery and metaphoric counseling are critical components to the required longer term Cognitive Restructuring. In both these interventions, [process correction and restructuring] the person is enabled and supported through various mechanisms, to stretch to describe their intuitions, to gradually bring the symbolic into language. For if I can describe it, I can begin to control it. Such stretching can be demonstrated by the concept of ‘laddering’. Laddering is a way of analyzing your internal monologue statements by looking for more and more basic underlying assumptions and predictions until you arrive at statements of core belief. The technique is called laddering because it proceeds step by step. Laddering has only two rules. Rule number 1 is to question yourself with the following format, and Rule number 2 is don’t answer with a feeling. The format is to ask:
‘What if ________________________? What does it mean to me?’
In the blank space the client writes a self-statement from his/her internal monologue. Then s/he writes the answer to the question. Having done that, have the client use the answer to fill in the blank and ask the question again. After using this sequence a few times, the client will arrive at a core belief. The answers must be confined to statements that express conclusions, beliefs or assumptions – not descriptions of feelings.
This stretching to put into words each new step epitomizes the process. This same stretching is used in metaphor counseling and other imagery processes.
A critical part of thinking is ‘meaning’. Experiences do not have meaning until we give meaning to them. The glass is half full or half empty. It depends on one’s perspective or ‘frame of reference’. Change the context and change the frame of reference, which changes the meaning. The usually connotation of the glass being half full is that this is an optimistic way of thinking. But if the content of the glass were toxic, having the glass half full would be a pessimistic way of thinking – too much of a bad thing. If you are with a beautiful woman or handsome man and are confident both of yourself and your relationship to this person, stares from others may be thought to be a compliment. However, if you are not confident of yourself or of your relationship with your partner, stares may constitute a threat.
“We don’t see things as they are. We see them as we are.” — Anais Nin
The process of ‘reframing’ is another major process in Cognitive Behavior ManagementSM. The creation of alternative meaning in the five step Cognitive Process Correction is a process of reframing the experience so that the meaning will be less distressing. Another way of doing this is to dissociate from the experience through imagery and then, from this detached frame of reference the experience may become different than the memory of the experience. Dissociation is a metaperceptive process. The process of using metaperceptions [visualization, imagining] for the purposes of helping people change is not new. Cognitive clinicians have been doing this for years. However, over time, we have expanded the dimensions considerably. We can, for example perceive ourselves in regard to time as 1) in the present, 2) in the past, or 3) in the future. We can also change space, the place and the circumstances in which we find ourselves.
In addition, we can perceive ourselves in what are called positions, we can view ourselves in the first position as actually the one experiencing the event, in the second position, as the other person in the experience, or the third position, as a by-stander watching the event occur from the outside. The movement to these different positions changes the emotional content of the experience as it modifies the degree of association or dissociation with the experience. Thus we can view ourselves as in a movie, experiencing a phobic reaction to a stimulus, without feeling the emotional fear in the process. Or, conversely, we can view that same experience from the first position, where we are experiencing all of the emotion, as a process of desensitizing ourselves to the emotional feelings caused by the stimulus through imagined exposure.
These metaperceptive techniques, combined with a stretching to articulate the intuitive symbols are critical to the ability to restructure the maladaptive schema of people who have been invalidated in early childhood.
Culture Restructuring is the prevention aspect of Cognitive Behavior ManagementSM. This is so because children do not form their ‘inner logic’ or theory of meaning, without a little help from their friends.
A father saw out of the corner of his eye, his three-year-old child jump into the twelve-foot end of the pool. The father slid into the pool and saw the child rising to the surface. As the child broke the surface the father picked him up out of the water and ………
What the father does will set the tone for the experience for the child. In this case, the child was just about to cry when the father tossed him into the air and laughed. The child then laughed too. The experience changed from one of fright to fun. The down side, of course, was that the child kept jumping into the deep end and the father had to be alert. The upside is that the child very quickly learned to swim.
The father sent the child a message about the experience and fathers, mothers, sisters, brothers, aunts, uncles, teacher, etc., do this nonconsciously all the time. Usually, these messages are tolerable, although most often they could be improved. Unfortunately, sometimes these messages invalidate the child and are psycotraumatizing. And these very negative messages happen most often when the child is very young. Such messages are likely to lead to severe and persistent problems in living.
Some of these messages can be improved by changing the culture and getting everyone in the culture to provide balanced and rational messages. To add to the grievance of what has occurred at home, the child’s behavior may cause other adults in the childcare center or school to add to the burden. Inappropriate behavior tends to generate inappropriate responses. When a child calls a parent, clinician or teacher a #^@(^^, what is the response – and does the response reinforce the child’s beliefs about other people or generate dissonance. Parents generally respond as human beings having had no special training in being a care manager. Unfortunately, most clinicians and teachers will also respond personally, not professionally. They will get angry and punish the child – reinforcing the child’s belief that adults really are #^@(^^.
In Culture Restructuring, the adults are taught to be mindful of the messages they send to children regardless of the circumstances. This should be easier, of course, in a professional arena, but that is not usually the case. Mental health, for example, has such derogatory and destructive jargon that it carries major potential to psycho-traumatize a person who may already have a maladaptive inner logic. The professional depersonalizes the individual and attempts to control their behavior because of a belief that the individual cannot control his/her own behavior. This is the epitome of a maladaptive message.
Mindfulness is like becoming an impartial spectator, trying to observe your own behavior as if you were observing the behavior of another. The Impartial Spectator is a concept that Adam Smith used as the central feature of his book, The Theory of Moral Sentiments. He defined the Impartial Spectator as the capacity to stand outside yourself and watch yourself in action, which is essentially the same mental action as the ancient Buddhist concept of mindful awareness, and is the second position in meta-perceptions.
Adam Smith understood that keeping the perspective of the Impartial Spectator under painful circumstances is hard work, requiring, in his words, the ‘utmost and most fatiguing exertions’. But it is just such exertions that are required of teachers and clinicians if we are to overcome the ‘inner logic’ of an invalidated and psycho-traumatized child.
By teaching people in the culture what to say and not to say, both to themselves and to others, in order to reach certain outcomes and by supplying them with specific techniques such as attribution training, we can begin to provide a culture which will teach the child balanced and rational meanings for self and others and dispute distorted points of view.
Finally, Cognitive Behavior ManagementSM includes Social Skill Training, although on this site we do not spend a lot of time mentioning it. The reason for that is because of the excellent work done by others in that arena. Arnold P. Goldstein, for example, in his book The Prepare Curriculum covers the ground much better than we could here. It is worthwhile to note, perhaps, that his ‘improvements’ of that book do not appear to be nearly as good as the original. Nonetheless, Goldstein and others have made significant inroads toward providing the skills necessary to the delivery of Social Skill Training. Another worthy contribution comes in the corrections field from Positive Solutions Associates, although this is not quite as accessible due to costs. PSA provides quality field-generated and research-supported cognitive skills programs. According to Michael Voron of PSA, this approach is different because it does not tell offenders how to simply follow the rules, but challenges their choices and seeks to build the cognitive skills necessary so that following the rules becomes a positive intrinsic choice.
We hope to do as well in compiling a compendium of skills in Cognitive Process Correction, Cognitive Restructuring, Culture Restructuring and other techniques which fit into these categories.
Jerome R. Gardner