The literal meaning of Latin assidere, ultimate source of assess, was to ‘sit beside someone’… This developed a secondary meaning ‘sit next to as judge and assist in the deliberations, particularly in fixing the amount of a fine or tax to be paid’. The original meaning of diagnosis was ‘knowing apart’. In classical times the general notion of ‘distinguishing’ or ‘discerning’ was applied.
Thus, the concept of assessment and diagnosis is one of adjudication, or bringing a judgement to bear. In fact, the very nature of assessing or diagnosing an individual is the keystone to the ‘expert’ model of human services. The notion of need is one that connects to an expert standard from which the individual varies, and thus this deficit determined by the ‘expert’ then leads to the remedial action.
This construct is exposed in the traditional use of a functional behavioral assessment, a process that seeks to identify the ‘problem’ behavior a child or adolescent may exhibit, particularly in school, to determine the function or purpose of the behavior, and to develop interventions to teach acceptable alternatives to the behavior.
Traditionally the process starts with an identification of the behavior that needs to change and then proceeds with the following steps.
- Collect data on the behavior,
- Develop a ‘hypothesis’ (best guess) about the reason for the behavior,
- Develop an intervention to help change the behavior,
- Evaluate the effectiveness of the intervention, and
- Revise as needed.
The determination of what behaviors need to be changed is most often a decision of those adults who are in authority. There are several difficulties with this beginning that need to be examined.
Because the basic FBA was a behavioral approach conceived in regard to children who had developmental difficulties, it was considered to be appropriate that society, as represented by those adults in authority, should shape the behavioral development of a disabled child. After all, it is these adults who are the conveyers of the cultural norms and mores of the social unit. However, as the method is applied to a second group of children who have already learned their behavior developmentally within a cultural unit, this approach has necessarily become a coercive process.
The first group of developmentally delayed children can be defined as having a deficit in their behavioral repertoire. They simply have not learned how to achieve certain goals and intents because of the developmental delay that has deferred such learning. The second group of developmentally adept children, however, can best be defined as having a distorted view of when and where to use certain behaviors that have already been learned. This distortion may have occurred because 1) the basic social unit for teaching behaviors, the family, has different norms and mores; or 2) because the nuances of behavior selection are not understood – for example, certain prejudices or partialities were conveyed in the teaching that are allowed within the culture promoting unit, but are to be hidden elsewhere; or 3) because of the interpretation of the teaching that the individual child has brought to the situation.
For the first group of developmentally delayed, there is some validity in the traditional approach since the concept is that these children are trying to achieve some goal, but that the behavior they are using is not functionally valid. Since they can be considered to have a limited behavior repertoire and are presumed to not be able to clearly communicate their goals, desire and intents, we might need to infer these factors and teach the appropriate behavior to achieve that which is desired, but not expressed.
For the second group, who display distortion rather than deficit, the traditional approach merely reinforces the behavior that the environmental experts views as inappropriate. This is so because the adults in authority act in exactly the manner that the distorted ‘inner logic’ predicts. Therefore, the behavior has the exact outcome that is expected. For example, “These people don’t like me and therefore they are likely to repress or oppress me – behavior occurs – See, I was right! They are altering the environment and consequences to make me do what they want!”.
This second group generally has no deficit in the behavioral repertoire [although some may be found as the process continues], but rather has made a selection of behaviors based on what they believe [think] about the situation. The mental context or inner logic, with maladaptive mental schema and cognitive errors, creates the reality of a priori assumptions with which the selection of response is made. Thus, the decision about why the child in this second group perceives the world the way s/he does is a decisive factor and this requires that we begin to gain some understanding of what is in, what the behaviorists call, the ‘black box’.
This discussion is particularly concerned with the second group of children and seeks for them a very different approach to assessment than the traditional functional behavior assessment. The approach is based upon a pivotal concept of preference instead of pathology. The new question to be addressed is not what is wrong with the subject or what concerns us about the subject, but rather, about what is the subject concerned? This is a very different question that switches the focus about whose problem we wish to address. Do we wish to address the problem that other people are having with the subject child, or do we wish to address the subject child’s problem?
Such a shift in focus can raise a great many questions, most of which are embodied in the inquiry, ‘what if the subject is not concerned about those things that society and the people around him/her are concerned about?’. This anxiety that the subject is not influenced by the same things as everyone else is generally unfounded. There are some fundamental compatibilities among people. The major one is that almost all of us are concerned about relationships between self and others. If such relationships are not mutually satisfying and gratifying, we may differ as to the cause of our dissatisfaction, but we tend to all experience the dissatisfaction. Further, we all use the same symbolic perceptions to see these relationships. The processes of social interaction have unintended consequences, in that they ‘create’ ‘things’ that are only subsequently articulatable (or discoverable) as ‘things’; and that the ‘things’ that result from this ‘social construction’ have an intrinsic ordering to them that constrains the order in which we come to ‘apprehend’ them [Elias, 1978].
We can elicit these ‘things’ that result from social interaction and help people articulate them in ways that they have not yet conceived. Eliciting is the process of asking a person questions in order to understand their mental processes, including thoughts, ideas, images, and sensations. By eliciting a mental process about self, others and future expectations, a person can understand a great deal about how a person processes about these relationships and how these ‘thoughts’ direct their behaviors.
Elicit means to draw forth [what is latent or potential]; to educe truths from data; extract information from persons. Thus the elicitor does not operate from preconceived expert opinions about what is and what ought to be, but rather listens to what is as perceived by the subject. And what is, is a hierarchy of thought and subsequent action that is oriented towards achieving the best possible outcome for the individual subject. It is from this elicitation, in detail, of mental contexts that a subject is able to begin to define with some beginning clarity what they would prefer to have happen and what they would need to change in order for this preference to occur. Only as the evaluator and subject begin to understand the ‘inner logic’ does the behavior become accessible to change. Eliciting without judgement requires considerable skill. It requires the mind of a beginner.
“The mind of the beginner is empty, free of the habits of the expert, ready to accept, to doubt, and open to all the possibilities. In the beginner’s mind there are many possibilities, but in the expert’s there are few. When you listen to someone, you should give up all your preconceived ideas and your subjective opinions; you should just listen, just observe what his/her way is. Put very little emphasis on right and wrong or good and bad, just see things as they are with him/her, and accept them.” [Suzuki] “Usually when you listen to some statement, you hear it as a kind of echo of yourself. The flow of consciousness is not the fixed repetitive patterns of our usual self-centered consciousness, but rather arises spontaneously and naturally from the actual circumstances of the present. Live in the reality of the present.” [Suzuki].
This is very difficult for most of us to do. It is particularly difficult when you have a vast amount of experience in the area you are eliciting, thus people experienced and highly skilled in traditional assessment may find it most difficult. It helps to go very, very slow and to know the right things to listen for. Part of the art of eliciting is being alert to those moments where the subject has no objective or conscious reason for doing what they do. When the subject takes it for granted that they “just know”, there are underlying mental states that make its so [Lady].
A lot of the most important stuff is below the threshold of consciousness, so you really have to slow the subject down so s/he can become aware of what s/he’s doing. Mental contexts are relatively enduring structures that are unconscious, but can evoke and be evoked by conscious events. Conscious contents and unconscious contents interweave to create a “stream of consciousness”. [Baar]
One plausible meaning of ‘self’ is that it is the dominant enduring context of many conscious experiences. Thus the concept of ‘self’ is embodied in the thoughts about self as experienced and learned. The fact that people become unconscious of a repetitive or predictable stimulus does not mean that the stimulus has disappeared; on the contrary, it continues to be processed in the appropriate input system. The decline in orienting to redundant stimuli is something very functional for the nervous system. One may say that the loss of consciousness of a predictable event ‘is’ the signal that the event has been learned completely. Thus the ‘self’ is unknown, or at least nonconscious. The process of elicitation therefore become a process of bringing the self into a conscious arena so that it can be (self) evaluated. [Baar]
Another key point in eliciting is that you can’t learn much by listening to a subject talk about what s/he does in the abstract. You need to watch the subject actually do it – or at least pretend to do it. Have the subject pick up the phone to deal with a call. “Don’t assume the caller is already on the line. Start when the phone rings.” And the subject has to be willing to put up with the fact that you are going to constantly be interrupting with questions. [Lady]
In many cases, eye-accessing cues are very helpful. It’s not so much a matter of putting an interpretation on the eye movements. It’s that the moment the eyes move lets you know that it’s time to interrupt with a question. “What happened just now? What did you just do? Are you seeing a picture of something?” It seems that eye movement can signal the movement to another mental context. [Lady]
Other non-verbal cues can also be important in the same way. “What does that mean – that gesture you just made? What was going on in your mind when you made that gesture?” “I noticed that when you first started your leg kept jerking up and down fairly rapidly. And then at a certain point the leg stopped moving. Go back to the point when the leg stopped moving and tell me what was going on in your mind.” [Lady]
Slips of speech and action generally show a pattern of decomposition along natural fault lines. Deletion error – insertion error – component exchange – ‘behavioral spoonerism’. In all – errors, action components are inserted, deleted and exchanged in a smooth, normal, seemingly volitional fashion. Only as you stop the subject’s thought processes and ask him/her to look in depth at what s/he is doing, can you begin to help the person understand the subjective consequence of his/her own thoughts.
Action schemata seem to compete for the privilege of participating in an action, to the point where they sometimes enter into the wrong context. You will notice by the way, if you are truly listening, that the ‘contradictions’ between the two mental contexts may cause the subject to make the problem conscious; without such contradictions we seem to go blithely along with several different nonconscious schemas.
Evidently people need two abilities that seem at odds with each other: the ability to call on complex functions in a unitary way, and ‘also’ the ability to decompose and reorganize the same functions when the task or context changes. It is the latter ability that allows for change to occur.
The art of asking a person questions about their subjective experience is the most difficult of all aspects to learn. The average person has no competence at all in eliciting. But for the person who wants to scientifically study the structure of subjective experience, in order to provide a method for restructuring that experience, eliciting is where the real interest is. Not only do you as the elicitor learn about what is occurring, the subject is often learning of these nonconscious events at the same time.
Making the Plan
It is not sufficient for an evaluator to suggest that a subject has a thought disorder, without determining what are the disordered thoughts; or to suggest that the person is not connected to reality [as most of us would understand it], without an articulation of what reality the subject is connected to. Evaluations must lead to planning recommendations.
There are three processes usually used to evaluate an individual person’s life functioning: 1) testing, 2) eliciting and 3) observation. The testing is usually used to define the baseline performance of a specific skill or ability. Each test has an implied standard against which the person is judged. The eliciting and observation, are of a different nature. The standard in the eliciting is, as we have already defined, the preferences of the subject him/herself.
The observation standard is usually set by the social context. From the earliest period of history to the present, social functions have become more and more differentiated under the pressure of competition. The more differentiated they become, the larger grows the number of functions and thus of people on whom the individual constantly depends in all his actions, from the simplest and most commonplace to the more complex and uncommon. As more and more people must attune their conduct to that of others, the web of actions must be organized more and more strictly and accurately, if each individual action is to fulfill its social function. The individual is compelled to regulate his conduct in an increasingly differentiated, more even and more stable manner (Elias, 1982).
Yet we continue to find persons who do not regulate their conduct in such social contexts. And it is the discrepancy between the mental context and social context that is often the area of discontent. When the mental context and the social contest are not attuned, the person experiences ‘problems in living’. Elias establishes the historical course of elaborating practices for dealing with the assorted social contexts. Some behaviors become unacceptable over time. But, in the process, embarrassment is being invented. Embarrassment is a (metacognitive) emotional state created by the explication into discourse of this hierarchy: for it to be realized, a self-censorious ability has to be established. People have to become able to reflect on their own behavior – that is, on how they act in company – where previously they had not done so.
If the person is unable to reflect upon his/her own behavior and to determine how their behavior affects others in a social context, the unhappy result is problems in living – problems in finding mutually satisfying and gratifying relationships. Determining what needs to be addressed to minimize this discrepancy requires that one understand both the mental context upon which the discrepancy is based and the standard under which the subject is operating. Cognitive errors come into play. The subject personalizes, or generalizes, beyond all acceptable rules, and finds him/herself in unhappy consequences without an understanding of what needs to change – only that they seek a different outcome to the scenario. By helping the person change perspectives: seeing themselves in the situation from a third position, changing the temporal and spatial context, ‘future pacing’, one can begin to help them make decisions which will impact upon how they behave.
A man is literally what he thinks, his character being the complete sum of all his thoughts.
James Allen [1864-1912]
We are aware that people have a thought stream which comments on all events and experiences as they happen. Such inner speech is usually nonconscious and reflexive, meaning, that like other reflexive behaviors such as breathing and blinking, we rarely notice that they are happening, unless or until, there is reason to bring the experience into consciousness.
Inner speech is one of the most important modes of experience. Most of us go around talking to ourselves, though we may be reluctant to do so out loud. We may be so accustomed to the inner voice that we are no longer aware of its existence ‘metacognitively’…the inner voice maintains a running commentary about our experiences, feelings and relationships with others; it comments on past events and helps to make plans for the future [Klinger – 1971].
If we really want to know what is in the ‘black box’ we must elicit nonconscious processes of which the person themselves are unaware. We must help them access consciously their own mental contexts. Such contexts, you will remember, are relatively enduring structures that are nonconscious, but can evoke and be evoked by conscious events.
“The concepts of self and culture are interdependent: one cannot exist without the other. Thus, while it has become commonplace to regard the self as a cultural product, and enquire as to the ‘environmental’ (cultural) factors that lead to the expression or inhibition of this or that aspect of the self, we must not forget the reverse perspective; that culture itself is a product of the self. Selves are constituted within culture, and culture is maintained by the community of selves” [Lock, 2000].
This interactive quality of self and culture is difficult to measure. The cause and effect of such interactivity is not clear. At any given moment, the ‘self’ may make a decision about the culture that affects and changes the culture. In fact, ‘seeding the culture’ or restructuring the culture is a clear cognitive intervention. Dubin  suggests that culture is best seen as a set of control mechanisms – plans, recipes, rules, instructions, which are the principal bases for the specificity of behavior and an essential condition for governing it. The plans, recipes, rules, instructions, etc. which make up a larger culture, however, may be modified by the selves in the smaller segments. It can be argued that any defined segment of culture has a smaller component which may have variance down to the ‘culture’, or if you prefer, ‘personality’ of the individual person.
In this construction, the ‘personality’ is composed of the plans, recipes, rules and instructions of the individual person; the a priori assumptions the person makes about himself and others in the world. The question is, what plans, recipes, rules and constructions has a child learned from his/her culture. As Lock indicates, both the messenger and the receiver are responsible for the learned outcome. Subjective experience is not an environmental variable. Many people think of their feelings and the pictures that flash through their minds and the words that go through their heads as being things that just happen, or perhaps are caused by externals: “She makes me mad” or “It makes me happy when X happens”.
One of the most popular pieces of wisdom nowadays is that “Nobody can make anybody else feel anything. Nobody can make you mad – it’s up to you whether you get mad or not.” Taken literally, this is untrue – of course we all influence each other’s emotions. Nonetheless, it’s what we might call a ‘useful lie’ – sure, externals affect our emotions, but accepting the belief that we have the responsibility for our own emotions is much more useful to us in having a satisfying life than acting out of the belief that the external world creates our emotions for us [Lady]
Just telling people, though, in a sincere tone of voice, to take responsibility for their own emotions isn’t very effective, although it seems to be what a lot of therapists do. What one needs is to find ways of actually giving people the experience of creating their own emotions.
It is these cultural or personality components and their nuances that we seek to elicit. In the process of doing so, we are aware that there are certain errors or distortions that are relatively common. Most often they are defined by the eight categories listed below and their presence can be identified by ‘leakage’ of the ‘inner speech’ that occurs in self-talk.
- Filtering: You focus on the negative details while ignoring all the positive aspects of a situation.
Polarized Thinking: Things are black or white, good or bad. You have to be perfect or you’re a failure. There’s no middle ground, no room for mistakes.
- Overgeneralization: You reach a general conclusion based on a single incident or piece of evidence. You exaggerate the frequency of problems and use negative global labels.
- Mind Reading: Without their saying so, you know what people are feeling and why they act the way they do. In particular, you have certain knowledge of how people think and feel about you.
- Catastrophizing: You expect, even visualize disaster. You notice or hear about a problem and start asking, “What if?” What if tragedy strikes? What if it happens to me?
- Magnifying: You exaggerate the degree or intensity of a problem. You turn up the volume on anything bad, making it loud, large, and overwhelming.
- Personalization: You assume that everything people do or say is some kind of reaction to you. You also compare yourself to others, trying to determine who is smarter, more competent, better looking, and so on.
- Shoulds: You have a list of ironclad rules about how you and other people should act. People who break the rules anger you, and you feel guilty when you violate the rules.
These errors can provide a significant perspective on why a behavior is selected, whether there is a behavior deficit and/or distortion, and how you can effectively create an intervention plan to address the problems in living that are caused. If you believe, for example, that the people around you should behave in certain ways and they don’t behave in that way, it is likely that you will be offended and act in a complementary fashion. However, if no one else believes as you do, the offense is incomprehensible. Thus until the helper and the child examine the ‘inner logic’ of these beliefs which are held nonconsciously, it will be unlikely that an hypothesis about behavior can be adequately created.
Two other cognitive errors can be added.
- Externalizing: The person explains the cause of success and/or failure as external forces such as task difficulty or luck over which s/he has no control, instead of to his/her own effort. “It’s his fault! She doesn’t like me!”
- Prophesizing: The person has negative and relatively stable expectancy or generalized beliefs about a lack of self-competence in achievement situations. “I’m going to fail this test. Nobody is going to talk to me.” Prophecies of negative outcomes.
These two errors are connected to the expectancies that the person has for him/her self and relate to the core beliefs about future prospects. It should be obvious that if the person has negative beliefs about his/her future prospects, s/he is likely to e less moved by present consequences. Thus the cause becomes and effect and the effect a cause in nonlinear fashion.
The collection of this cognitive data is also an interactive process. One cannot assume that simply asking the person or observing him/her in certain situations is sufficient to determine what the cognitive errors and core beliefs are. After all ‘just because you are paranoid doesn’t mean that people aren’t out to get you!’. The process should be implemented through a group procedure for the initial inquiry. This will allow you not only to get an interactive feedback about what the child ‘leaks’ in terms of self-talk, but to gather the ‘leakage’ from the other participants as well. What are they thinking about when the child’s behavior disrupts them?
The assessor should then follow the rest of the process leading to the development of an individualized protocol for addressing the cognitive errors of the child.