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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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Emily Read Daniels posted:
Anne Katona-Linn posted:

Last comment for clarification...Emily, saying that "behavior strategies don't work" is not only incorrect...but I feel that such a bold statement has a lot of implications that you may not realize and isn't really "productive". It creates an "us" vs "them" in an already traumatic world in which we live. I'm going to quote Rodney King here..."can't we all just get along?!!" 

I am MORE than happy to discuss and problem-solve how behaviorism and other approaches can work together to create a holistic framework for addressing ACES. From all of my years dealing with my own trauma, I've learned that just ignoring the problem doesn't make it go away. In fact, it can get worse. It takes facing it and reframing it so it isn't so "scary" anymore. I know this may sound like a "Mission Impossible"...but I am here if "you choose to accept this mission". 

Hi Anne...Thank you for your reply.  I certainly DO NOT want to create "us" versus "them."  We don't need to be divided.  At the heart of who I am, I am a convener.  And I like rich discussion with varying view points. 

I also think It's important for us ALL to recognize that this movement challenges our current ways - current ways of thinking, doing, etc.  And it should.  But that isn't comfortable for any of us.  Whether you believe that my statement unfairly maligns behaviorism, it's my experience.  I think the one thing we can all agree on is that behaviorism has dominated the way in which we view and try and reshape behavior (at least in the public education realm).  We have done it;  we have implemented it;  we have tried it.  We still have LOTS and LOTS of behaviorally challenging students in public education.  How we handle that can make a big difference.  Honestly, I think this small blog exchange is just the tip of the iceberg in a much bigger cultural discussion about what we believe is the human condition and how do we support one another in the face of adversity. 

There is much we are challenged by (with the science behind ACES/trauma).  We are just beginning to have the "hard conversations."  But I welcome it...  I hope this feels like a better response for you.  XO

Emily,

Thank you...I appreciate your willingness to talk more about it! I think the key is that there is "no one size fits all" approach to ANYTHING.  Ultimately it comes down to what works...my experience is that behavior principles work but we need to allow for flexibility and make changes when something isn't working. I've had plenty of "talk-therapy" that did nothing to address my trauma. Until I identified that I needed "trauma-specific" therapy, I was spinning my wheels and very frustrated. I could say that "it didn't work"...but I won't because I received some benefit but it wasn't exactly what I needed. 

I've seen amazing things with behavior strategies through both SW-PBIS and PW-PBIS when it is done with fidelity, with coaching, support, buy-in, commitment, and love of the kids. I have seen things go bad when they are done with fidelity. You're right...this is the tip of the iceberg. 

Because behavior principles are so ingrained in education (and in the law), it's not likely to go away anytime soon. It DOES need to evolve and grow to integrate with other practices to create a more effective continuum of options for children and the teachers/staff who support them. I think it's a perfect opportunity with the momentum of the ACES/Trauma Informed Care movement right now. 

As a professional in this field, my own personal mantra is that "I don't know everything and I can ALWAYS learn from others"!! This is a great conversation and a learning opportunity for me...so I'm grateful!! 

PS. Yes, I like this last response better. I'm a convener too...so we COMPLETELY agree on one thing for sure!! Oh and that we are passionate about the kids we support!! 

Steve Brown, Psy.D. posted:

My apologies for anything redundant I said in my post. I didn't read the stream of comments below. Steve

Definitely no redundancy...it's always great to hear things stated a little differently. Thanks!!

Boy, does this hit home—the part about the gulf between cognitive behaviorism and a trauma-informed approach, that is. Forgive me if my understanding of any of this is rudimentary — I’m not a clinician. And I’m not trying to start any wars .

When I was in college in the 1980s, I was diagnosed with anxiety/depressive disorder and referred to a psychologist. This was a brand new world to me, so during my first appointment, one of my first questions to the doctor was, “aren’t we going to talk about my childhood”? Now, that expectation may have been based in part on stereotypes reinforced by the entertainment industry, but in retrospect, I know that it’s because even if I couldn’t articulate it at the time and didn’t yet know the first thing about trauma or ACEs (a phrase/acronym that wouldn’t be coined until a decade later), my adverse childhood experiences were at the root of my depression/anxiety. In fact, I’d hasten to add that the depression/anxiety were symptoms of C-PTSD (which I wouldn’t get diagnosed with for 20 more, very long years) as much as they were problems themselves. But the doctor’s response to my question? He laughed and said, “We could talk about your childhood for years and never get anywhere!”

So, together we applied cognitive behavioral approaches (again, I didn’t know anything about cognitive behaviorism or any other schools of psychology until years later) to try to resolve my depression/anxiety disorder. It did help, and I improved. I was able to function much better than I had previously, with fewer panic attacks and fewer overt symptoms of depression. And I finished that year of therapy with several therapeutic tools in hand that I use to this day. But I knew something still wasn’t quite right, that I wasn’t quite well. I wasn’t depressed, exactly, but I wasn’t exactly NOT depressed, was about the best I could come up with. So I lingered in limbo for a couple more decades until someone finally “got it”.

Turns out I was right — I did need to talk about my childhood, or at least address in one way or another certain aspects of it. I don’t blame the psychologist — this was the 1980s. I wasn’t presenting with substance abuse issues or run-ins with the law or difficulties holding down a job or suicide attempts. (Then again, I did admit to “cutting”, back then still known as “self-mutilation”, and his response was to sarcastically joke about it ...) I’m not sure where the understanding of trauma/PTSD was in the 1980s, especially in regard to people who hadn’t seen combat and were not “acting out” but instead internalizing, so I don’t know if there was anyone out there at the time who would have seen my case any differently or tried any more effective treatments. And I'm sure I'm one of millions with similar stories (and luckier than many of them, since I was able to get help). I’m grateful that the understanding and awareness of trauma and ACEs are as relatively advanced as they are today, though. We’ve come along way, baby.

Last edited by Laura Pinhey

Thanks for posting this, Laura. There are still people who think that skipping over what happened in your childhood to just acting differently is a better path than understanding and talking about your childhood. Once you know about ACEs science, that just doesn't make a lot of sense, as you explained so well. 

Thank you, Emily.  How very right on you are!  I have had the exact kind of gut wrenching  (where is could literally feel my insides jumping) conversations with behavioralists both in the school setting and also in Team meetings with Dept. of Child Services.

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