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What Happens When a "Behaviorist" has Dinner with a "Trauma-Informist"

 

Let me tell you, dinner with a behaviorist is an experience, a somatic experience.  Lily (name changed to protect her ;-) ) and I shared Indian food two nights ago in Keene, NH. 

As I shuffled into the restaurant ten minutes late (typical me), I rounded the corner and saw her sitting at a table for two. I beamed; I knew I was in for some rich discussion and a total "nerding out" session. 

Lily and I are former colleagues. We worked together for only a year, but it was my first year in a new school. Lily was there — someone safe whom I could confide in. She is a school psychologist by training, but a self-proclaimed hard core "behaviorist." She even holds that title in her current job. 

The year we worked together, I often burst through her door, flopped on her couch (psycho-analytic style) and proclaimed, "God damn; these kids are killing me!" I was drowning in my new role as a teen crisis counselor. Furthermore, I was working in a school that wasn't familiar with unconventional means of counseling — like mindfulness and aromatherapy.

Lily listened to me bitch — a lot — about frustrations with trying to help kids in a system that relished the status quo. One of the biggest struggles was whether or not I was allowed to "service" special education students because I wasn't a school psychologist. I was like, "who gives a crap — kids should work with who they connect with."  See...that was trauma-informed thinking before I even knew what trauma-informed was. Lily always listened to me and in those days, we worked on crafting behavior plans together. We were both supporting some of the toughest kids — kids with entrenched patterns of truancy or substance abuse or high levels of aggression. We really cared and wanted to help our kids in the form and fashion they needed. Which is why I was eager to have the conversation with Lily about how behavioral approaches ARE NOT trauma-informed and how much of what we did together did not help our kids and may have even hurt them.

As Lily begins to explain her perspective on behaviorism, I feel my insides start to tremble. I can feel my nervous system activating. I am trying really hard to pay attention to what she is saying while being mindful of my body's stress response. Lily contends that behaviorists are only concerned with "surface, observable" behaviors. They identify the function of the behavior and determine how to reshape the behavior to meet the the function in a more adaptive manner.

"We all do what we do because we have been reinforced to do it," Lily said. "If someone irritates someone to gain attention, we just have to teach him to get his need met in a more adaptive way and reinforce that positively." 

I tell Lily the story of a kid that had been ignored by a teacher (on purpose — per his behavior plan) because he was asking her questions that were off topic to the task. The teacher ignored the boy and he asked louder and louder and began shouting. She turned her body away from him to "withdraw attention further" and he began to scream and eventually struck the teacher. Lily explained that this was likely an "extinction burst." 

I was quiet. I was really listening to what she was saying.  But I was shaking inside. Of course nothing she was saying was new to me; I had a shit ton of  behavioral training in my 15 years as a counselor (I chaired PBIS in one of my first schools). What I was trying to do was reconcile the behavioral perspective with my trauma training.  THEY DON'T. They don't align. 

That kid I was describing was a special education student with a history of trauma. The teacher's effort to reshape his behavior may have triggered a body memory of neglect or abuse. Whether that is what happened or not, it doesn't matter. The teacher did not feel good doing what she was doing and neither did the kid. In some ways, trauma-informed is really simple: human beings are human. We need to treat each other humanely. When we all become robots or some product of artificial intelligence, then a behavioral approach may be appropriate. Otherwise, we need to hang it up and be human instead. 

And just so you know, Lily acknowledges the limitations of behaviorism too.  She says she thinks it's probably not an appropriate modality for most kids with a trauma history. I wish she could announce that to all our area school districts that have multiple behaviorists on staff to deal with challenging classroom behaviors. Fortunately her saying that ushered in my settling response — she regulated me. I was able to embrace her with much warmth as we departed.  I can't wait till I get her more trained in practicing from a trauma-informed paradigm. Then she can become a "behaviorist in recovery."

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Anne Katona-Linn posted:

Emily,

I have to tell you that I laughed out loud when I saw the title of this in my e-mail!! THANK YOU SO MUCH for posting this discussion!!! Truly, it is something we need to talk about so all of those people traumatized by "behaviorists" can support each other and learn. (I am NOT being sarcastic!)

I have a confession...I'm a Board Certified Behavior Analyst, Special Education Teacher, and an Educational Psychologist. Not only that, I am a complex trauma THRIVER!! But WAIT...I'm currently a grant director helping to put mental health supports in schools using the School-wide PBIS framework...yadda, yadda, yadda!

With all that said, I respectfully disagree that the Trauma-Informed Care and Behavior Principles cannot be aligned or reconciled. In fact, I would argue that they help to strengthen each other. I see being "trauma-informed" as a critical piece of more successfully implementing positive behavior supports through a "trauma lens". The PBIS "framework" in particular gives the ADULTS the tools to help support the children in more effective and caring ways. 

I think the first thing is to actually address the definition of a "behaviorist". Many people have a limited scope of "behavior principles" being about rats, m&m's, planned ignoring, tokens, etc. Yes, they are often associated with "behavior management" but it does not really give the whole picture. It would be the same as me saying that a social worker is someone who gives families in need clothes or food. They DO, but that is one VERY small role that a social worker plays.

There are SO many ways in which TIC and Behavior principles are compatible: Applied Behavior Analysis (I'm sure you already know this but for the sake of the rest of the people) involves completing an assessment (gathering data or "information") to determine the function (the "why" or the "what happened to you") of a behavior, identifying antecedents ("trauma triggers") and consequences of this behavior (what do I get out of or get from the behavior...likely escape "trauma triggers" or get access to "safety"), and utilizing data to test and frequently retest hypotheses to help understand why individuals are doing what they do and improve their care in a socially significant way. This is VERY simplified, but it is the core of a LOT of behavior strategies.

When we apply this process to focus on supporting the adults and teaching them skills to be more proactive and not just "changing the child", they are more likely to be successful. If the adults feel "safe" by having more structure and feeling more competent, then they can more effectively support children who have been through trauma. I actually became a behavior analyst so I could understand my own trauma and the behaviors I've had over the years from not being treated for PTSD.

After 17 years of research, self-reflection, counseling (talk-therapy mostly and CBT), learning self-management/regulation skills, education (informal and formal), etc...the treatment that has been the most successful in my experience was EMDR. My counselor first "collected data" to identify the specifics of my trauma history in great detail. I had to identify the situation (people, places, things that trigger my response), my physical symptoms and mental self-talk as part of the "response"("Private behavior" which are thoughts, feelings, bodily reactions, etc.) so I can bring them to focus in order to "observe" them more objectively. These are all principles of applied behavior analysis.

"Behavior" strategies are like any other "tool" that we have...in the wrong hands, they can be dangerous and even deadly! This is why my mission in life is to understand my own experiences of both trauma and human behavior and use them for "good" and not for "evil". I hope this sheds some light on how both trauma-informed care and behaviorism can co-exist...and even get married to create a safe, positive, proactive, and supportive environment in our communities!! (mic drop) lol

PS. Disclaimer-I have seen PLENTY of "bad" Behavior Analysts and they do NOT represent ALL of us!! 

Hi Anne, Thank you so much for your lengthy and thoughtful response.  Although you articulate your position beautifully, I respectfully still disagree.  I am keenly aware of PBIS - having championed it in two of my previous schools.  I have extensive training in RENEW and functioned as a RENEW facilitator for four years. I literally built the system of RTI for behavioral interventions - and provided universal supports in all the schools I have worked in.  I lived in realm of "behaviorism" as the primary modality of social/emotional intervention.  Here's why I am in recovery from it: 

- first, it's artificial.  It's applying a linear, mechanistic model to human behavior which has complexity that isn't even fully captured in language.

- second, labeling the function of behavior in a behaviorist perspective is narrowly defined (i.e. to get attention, to avoid a task, to exert power/control, etc).  This titrated view of behavior assumes the person has some semblance of conscious control over his/her stress reaction - while it is happening.  

- third, the mechanistic manner of the behaviorist approach erodes the human context of connection.  We are biologically hardwired to connect - it's about physical proximity, tone of voice, gesture, prosody of speech, energy in the body, etc. When you are studying stimulus and response instead of resonance of another, you are no longer engaging in relationship.  You are engaging in research.  When you are looking to reshape a child's behavior because you deem it inappropriate, you aren't considering that the child may need that stress reaction to survive in another setting.  Furthermore, you aren't really considering the child - wholeheartedly.  

- Lastly, it doesn't work (can I get an "amen"?)  And even when it does, the behaviorist doesn't consider at what cost.  A disassociative state is a form of coping that looks a lot like compliance to many behaviorists.   

I would never say that all behavior is acceptable and should be tolerated.  But I have spent my whole adult life supporting challenging children.  The children that grew the most in their capacity for self regulation did so because I set healthy boundaries with them, meditated with them, "Reiki d" them, sang with them, listened to them, walked with them, played basketball with them, hiked with them...basically loved the hell out of them.  That's what kids need.  

Emily,

I have to tell you that I laughed out loud when I saw the title of this in my e-mail!! THANK YOU SO MUCH for posting this discussion!!! Truly, it is something we need to talk about so all of those people traumatized by "behaviorists" can support each other and learn. (I am NOT being sarcastic!)

I have a confession...I'm a Board Certified Behavior Analyst, Special Education Teacher, and an Educational Psychologist. Not only that, I am a complex trauma THRIVER!! But WAIT...I'm currently a grant director helping to put mental health supports in schools using the School-wide PBIS framework...yadda, yadda, yadda!

With all that said, I respectfully disagree that the Trauma-Informed Care and Behavior Principles cannot be aligned or reconciled. In fact, I would argue that they help to strengthen each other. I see being "trauma-informed" as a critical piece of more successfully implementing positive behavior supports through a "trauma lens". The PBIS "framework" in particular gives the ADULTS the tools to help support the children in more effective and caring ways. 

I think the first thing is to actually address the definition of a "behaviorist". Many people have a limited scope of "behavior principles" being about rats, m&m's, planned ignoring, tokens, etc. Yes, they are often associated with "behavior management" but it does not really give the whole picture. It would be the same as me saying that a social worker is someone who gives families in need clothes or food. They DO, but that is one VERY small role that a social worker plays.

There are SO many ways in which TIC and Behavior principles are compatible: Applied Behavior Analysis (I'm sure you already know this but for the sake of the rest of the people) involves completing an assessment (gathering data or "information") to determine the function (the "why" or the "what happened to you") of a behavior, identifying antecedents ("trauma triggers") and consequences of this behavior (what do I get out of or get from the behavior...likely escape "trauma triggers" or get access to "safety"), and utilizing data to test and frequently retest hypotheses to help understand why individuals are doing what they do and improve their care in a socially significant way. This is VERY simplified, but it is the core of a LOT of behavior strategies.

When we apply this process to focus on supporting the adults and teaching them skills to be more proactive and not just "changing the child", they are more likely to be successful. If the adults feel "safe" by having more structure and feeling more competent, then they can more effectively support children who have been through trauma. I actually became a behavior analyst so I could understand my own trauma and the behaviors I've had over the years from not being treated for PTSD.

After 17 years of research, self-reflection, counseling (talk-therapy mostly and CBT), learning self-management/regulation skills, education (informal and formal), etc...the treatment that has been the most successful in my experience was EMDR. My counselor first "collected data" to identify the specifics of my trauma history in great detail. I had to identify the situation (people, places, things that trigger my response), my physical symptoms and mental self-talk as part of the "response"("Private behavior" which are thoughts, feelings, bodily reactions, etc.) so I can bring them to focus in order to "observe" them more objectively. These are all principles of applied behavior analysis.

"Behavior" strategies are like any other "tool" that we have...in the wrong hands, they can be dangerous and even deadly! This is why my mission in life is to understand my own experiences of both trauma and human behavior and use them for "good" and not for "evil". I hope this sheds some light on how both trauma-informed care and behaviorism can co-exist...and even get married to create a safe, positive, proactive, and supportive environment in our communities!! (mic drop) lol

PS. Disclaimer-I have seen PLENTY of "bad" Behavior Analysts and they do NOT represent ALL of us!! 

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