Creating a decision support system for the creation of a plan of change is not a trivial task. One either must decide to create options for every possible occurrence, or determine some way of grouping the possible convergence of issues in a manner that will provide sufficient direction. We are loath to attempt to identify and label all possible individual human problems in living into the same kinds of categories used by the biomedical and psychodynamic practitioners, since we believe that such labels are rarely helpful and often harmful. While they have a certain degree of merit in helping professionals learn about possible manifestations, they too often provide negative and restrictive ways for lay people and the people with problems in living themselves to define and, perhaps, excuse, their own atypical behavior. Thus, ‘schizophrenia’ becomes a way of thinking about the person that diminishes other, more positive ways of conceiving that individual. Since our fundamental assumption is that people are the sum total of their thoughts – it is extremely unhelpful to provide negative ways for a person to think about him/herself.
For purposes of this Workbook, we will group in terms of the emotional cognitions that people have manifested. These emotional cognitions are utile terms used to define the degree of pleasure and/or pain that the individual believes s/he is experiencing. Cognitive Behavior Management is stimulus – thought:emotion – response. Thought:emotion is tied in this manner to emphasize that emotion is a thought or cognitive process. This emotional cognition [thought] concerns a value added to the original thought based on the original thought’s utility. The definition of utility is the pursuit of pleasure or the avoidance of pain. Thus, a thought that has ‘meaning’ to the individual contains some measure of pleasure and/or pain – whose interpretation equates to an emotion. The degree of emotional content derives from a comparison with past experiences.
Note that emotion, therefore, is not the same as ‘feeling’, which is a message [sensation] from the senses sent to the brain. Feeling in this context is the actual bodily change that is caused by a stimulus, which is then interpreted by a ‘recognition’ thought. That thought is then further interpreted to see if the thought has any ‘value’ for the future. If I stick you with a pin, this stimulus is likely to cause a ‘sting’, and you might interpret [recognize] this ‘sting’ as pain – e.g., “that is a pin that stuck me, that hurts”. The pain, in turn, may be interpreted as either significant or insignificant in value. In this case the interpretation may focus on the cause of this pain. “He trespassed on me and caused pain”. This may generate the emotional cognition of ‘anger’ toward me because of the belief that I trespassed on your space and caused harm. Or you may experience the emotional cognition of ‘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. The nature of your emotion is based upon your prior experiences with such situations and the context of this occurrence.
From this perspective, the thought ‘pain’ is a very interesting phenomenon, since pain is an interpretation as well. It is the one side of the ultimate value of utility. Cognitive pain management is specifically oriented toward helping an individual re-interpret the sensation in order to manage the degree of pain that s/he experiences. If you think about the prank of blindfolding a person and telling them that you are going to scald them and then you plunge his/her hand into freezing water, you will understand that the person interprets the sensation [message, signal] as pain, but that the pain they feel is not real. Since pain is an unusual emotional interpretation and has its major psychological importance in the degree of difference between the interpretation and the actual sensation, we will set it off to the side for purposes of this Workbook. But it is helpful in making the point that psychological pleasure and/or pain is also not real, but is an interpretation or meaning given to an experience by the person who has the experience. Based on prior experiences, the interpretation is idiosyncratic and may be dramatically different from person to person.
In getting back to the topology, to make a general grouping of emotions, we would first define a continuum between pleasure [attraction/attachment] and pain [avoidance]. While this seems straightforward enough, human beings are rather complex entities and can mix these seeming mutually exclusive notions together in quite unique ways. One important and interesting aspect of this complexity has to do with the identity of the ‘target’ of these emotional states. Loving yourself may actually be more beneficial than loving someone else. However, hating either yourself or others, justified or not, is a debilitating thought:emotion state.
As an example of a complex mixture of emotions, a child who is invalidated and psychotraumatized by his/her parents may both seek the love of those parents and try to avoid the pain caused by them. How the mix of thoughts about attraction and avoidance is created by the child will determine how s/he behaves or acts out the meaning of his/her thoughts. Often such a child will, as an adult, duplicate the same mixture of love and painful experiences that they have always tried to avoid. Part of what happens is that they may identify themselves as the obstacle and therefore, set in motion a process of trying to avoid and help others avoid themselves. They find themselves in a never-ending cycle of trying to achieve the love experience from a painful situation, even to the point of recreating a painful situation.
The behaviors that extend from this type of distortion of thought:emotion are often labeled, but the cause [the thought:emotion trait] is rarely ever addressed. This is because the practitioners themselves have not sorted out the thought:emotion configuration that the person is experiencing. A focus on pathology does not concern itself with the thought:emotion states of people with problems in living, despite the fact that such information is collected in order to determine the label [diagnosis] to be applied. In order to help orient assessment and intervention specialists to the thought:emotion trait process, and allow them to make use of these aspects within a plan and implementation for change, we have grouped our plan of change recommendations based upon the assessment specialist’s designation of the thought:emotion traits of the individual.
Our categorical separation starts with the attraction/attachment – [love]/[hate] – avoidance continuum and then separates the hate category into a continuum of fear/anger. Fear and anger are highly related states, separated only by one’s own estimate of self-competence in the area of defense. If you think you are competent to defend yourself against trespass, anger will predominate. If you do not feel so competent, then fear will predominate. Since you may feel competent or not, due to external circumstances, you may go back and forth between fear and anger. Depending on the intensity of the fear you may flee or become immobile [or unable to distance yourself from the danger]. Finally, we separate out one category of self-love/hate or self concept as an area where the mixture of the other three defined thought:emotion states are the most powerful.
Under the attraction/attachment or love category, we are looking at the continuum of attraction/attachment as ranging from love to abandonment. Abandonment requires that there be a ‘love object’ which has been lost or has rejected the lover. Generally, the thought:emotions connected to the abandonment side is sadness, hopelessness, and helplessness. However, these thought:emotion states can also lead to anger [feelings of being trespassed] and or fear [anxiety at being alone]. The fear can, of course, lead to ‘blaming’ oneself, while the anger almost always targets the ‘other’. [See attached Chart for clarification]
Given this orientation, we have grouped the definitions:
Anxiety
General: Worry, which is the major characteristic of general anxiety, is a problem
solving deficit. Worry (manifesting itself as ‘concern’) used effectively provides a person with a period of time to concentrate on solving the problem. When the problem is not solved, worry might continue in an unproductive but anxiety reinforcing manner.
Perfectionism: is an anxiety about making mistakes. A perfectionist probably has
self-affirmation difficulties as well as some of the characteristics of
obsession/compulsion.
Procrastination: combines poor time management and problem solving skills with
perfectionism and performance anxiety.
Obsession/ Obsessional thinking consists of recurrent thoughts or
compulsion: impulses or images – this is not ordinary worry since it is excessive,
unreasonable and time consuming. The compulsions are the
implementation of rituals to avoid the fearful outcomes of the
obsessional thoughts.
Phobia: excessive or unreasonable fear that causes the individual to go beyond
normal caution.
Panic: an intense or acute fear that is a misinterpretation of somatic sensations
that creates catastrophizing thought of death or psychological
breakdown
Anger
Opposition: a consistent refusal to follow the rules defined by others. Explosive or
noncompliant behavior may be best understood as a learning difficulty
rather than as a goal oriented form of behavior. As a result, it is important
to identify who has taught and is maintaining the present behavior and to
intervene with these parties as well.
Impulsive behavior: This does not fit well the anger thought:emotion state. It stems from
either a lack of self regulatory control [inhibition] or failure to
recognize and evaluate danger. The first part of this definition leads
to angry confrontation with others, since the individual is essentially
saying that s/he wants to do what s/he wants to do when s/he
wants to do it. The other half is concerned with a risk assessment
problem. Either of these is best described as a learning deficit and
is enhanced by self instruction techniques.
Attachment
Depression: The major characteristics are sadness, hopelessness and helplessness.
Depression is the result of loss of attachment to persons or things of value
and differs from normal grief in that it moves from sadness to helplessness
[victimization]. Depression also tends to generate sympathy, which can
become a secondary benefit [reinforcement] of the thought:emotion trait.
Abandonment: The major characteristic of abandonment is separation anxiety, and
on this basis abandonment is both an attachment and an anxiety
problem. Thoughts of abandonment usually occur in childhood with
the loss of a primary caretaker. The individual is then anxious about
the loss of other significant people in his/her life. In sufficient
intensity, s/he is likely to become self- or other-blaming.
Finally, we have the mixed thought:emotion categories:
Self Concept
Low Self Affirmation Often characterized by the thought:emotions of shame and
guilt – feelings of responsibility for anything that goes wrong.
Early sexual, physical and/or emotional abuse frequently
contribute to a belief of being ‘damaged goods’ – beliefs of
being unworthy of love and happiness – of tragedy seen as a
well-deserved punishment.
Self Blaming Personality Extreme self hatred combined with fear and distrust of others – feels unworthy of others – often invalidated and
psychotraumatized by people who should nurture.
Other Blaming Personality General self hatred combined with anger and hatred of
others – feels ‘victimized’ by others.
Confused Personality Unable to determine where they and others fit with each
other – subject to invalidation and double binds – unsure of
self and others.
It should be apparent that these categories are not mutually exclusive and that overlap is common. It is up to the assessment specialist to determine the degree of maladaptive thought:emotion and to make the recommendations that meet the level of distorted thinking that the individual child presents. The assessment specialist may find it useful to develop for him/herself a Likert scale of five to seven points to indicate the degree of concern. For example:
Self Concept Low Self Affirmation Personality Issues
1 2 3 4 5
Key:
1 = T:E of not being ‘good enough’ in most areas of life
2 = T:E of shame and guilt – believes s/he is ‘damaged goods’
3 = T:E of self hatred – need to be punished – unworthy
4 = T:E of self and other hatred – feelings of both victimhood and superhuman strength to endure
5 = T:E of confusion about who s/he is and how s/he fits in the world
The key to this strategy is the Key. The assessment specialist will make his/her own definitions, but will articulate the degree of difference and will compare this individual to other individuals in the assessment specialist’s own experience.
This determination, of course, influences the recommendations. For the personality issues of 3, 4, and 5, in the example above, a full scale cognitive restructuring program seems appropriate.
MAKING RECOMMENDATIONS
The assessment specialist has a responsibility for making specific recommendations for interventions to address the competency issues and may, have the responsibility for providing training to address these issues.
In developing recommendations, it is important that s/he identify all three elements of the issue – e.g., the maladaptive thought, resulting emotional status and the resulting behavior. Recognize that it is the thought that sets this chain of events in motion. Thus, a thought – “I’m stupid” – may generate a variety of different emotions [e.g., anger, sadness, shame, etc.] and the motivating factor of the emotional state leads to likely behaviors.
For example, the “I’m stupid” thought may lead to a predominant emotional state of anger, which is likely to lead to aggression and retaliation behavior. The same thought may lead to a predominant emotional state of sadness and withdrawal from peers. Two different plans of change would evolve. However, we need to emphasize that both anger and sadness could result from the maladaptive thought. The assessment specialist may need to identify the predominant emotion:action for primary intervention and then plan to follow up with a secondary action to deal with the other issues.
This example can be dealt with at three levels.
Thought: One can help the child address his/her maladaptive thoughts through a Cognitive Process Correction intervention that is built on the five steps
of:
Awareness: Helping the child become aware of his/her automatic or reflex thoughts through identifying the ‘leakage’ when the child talks to him/herself during crisis.
Attendance: Through the use of counting, thought journals and the like, the child is taught to be mindful of his automatic [self] talk and to slow it down.
Analysis: The child is then taught a formal process of seeking evidence for or against the meaning of his thought. In this case, is s/he really stupid? And the child learns to dispute such thoughts.
Alternatives: The child is asked to explore other meanings for his/her thought and to state these alternatives in a balanced and rational way. S/he may, for example decide that s/he is not as quick as some other kids in school learning [scientific learning] but is far brighter in spontaneous learning [street smart]. Or perhaps s/he will decide that she is rather bright, but does not learn in the same way as other kids. Or perhaps, she will need to accept that s/he is slower than others, but that s/he is capable in many other ways. Whatever, the outcome of this analysis, s/he will then need to look at the potential consequences of the new meaning, and decide which one is most helpful to him/her.
Adaptation: Finally, the child will need to learn the new thought and habituate it to memory so that it becomes an automatic thought. We should be cautious that in stressful situations, s/he may for a while revert to the old thought, emotion and action and this makes it worthwhile to provide other skills in calming and affirmations. It is also important to provide environmental supports in antecedent internal attributions and reinforcement.
Emotion: The process of learning emotional competence consists primarily of a psychoeducational approach to learning to identify emotions and their intensity. Several good curriculums are available that would be worthwhile for the teacher to use with all classmates, but can be taught individually as well.
It may be worthwhile as well to use the Self Concept Inventory as a method of helping the child learn to use balanced and rational statements about even those things s/he is dissatisified with.
Behavior: The child may additionally need to learn some new behaviors. For example, if s/he has not made friends because of the his/her psychological state, s/he may not now know how, even though s/he may be ready to do so.
We may also have identified a skill deficit which causes the thought in the first place. Children either learn to read almost automatically or they have severe difficulty with reading. If s/he can’t read, s/he may have decided that it is because s/he is stupid, not that s/he needs special help. Addressing the reading difficulty once s/he is able to have a balanced and rational thought about him/herself is critical to the maintenance of this new thought.
CONCLUSIONS:
The process of assessment and making recommendations for correction is not a trivial circumstance. For better or worse, the future of children is at stake. It is important, therefore, that the child always receive messages which in essence state “I’m OK and you are OK”. Merely diagnosing and labeling is not a good message. The presence of useful recommendations indicate to the child, the family and the teachers that this child is OK even though s/he may need some help. This is particularly critical for those children whose behavior is seen as the problem [meaning that no other disability exists].
It is also important that we recognize that the assessment specialist also has a responsibility to help to reshape the messages the child receives and this entails addressing the thoughts of parents and teachers. If a child thinks s/he is stupid, this is being reinforced somewhere. The assessment process should determine where this reinforcement is coming from and provide steps to change that message. We strongly recommend the Functional Cognitive Behavior Assessment [FCBA] with a Community Assessment/Support Team and a way to make this work most effectively.