Clinical Behavior Analysis: Considering Services to Persons with Social/Environmental Traumas

There is a huge amount of literature with regards to services to and different treatment approaches for victims of social/emotional and/or environmental traumas. A problem is that while a given treatment model may help some, it won’t all.

To start this discussion, consider any treatment the literature proclaims 'statistically significant.' While that would indicate statistical value for the larger group, it

1. Does not identify individual needs and differences across the group;

2. Very often misses relevant anomalies among individuals in the group;

3. Cannot describe how the individuals whom made gains did so...or could have done better; and

4. Most often overlooks entirely those persons/participants for whom the selected treatment was not successful (persons who did not fall in the 'statistically significant' range).

So, too with trauma related need....

In my professional experience, social/environmental trauma can be over assumed as having a primary, or predominate, impact and especially so in children. No matter how relevant, having experienced trauma inducing conditions doesn't mean that trauma should be the primary point of intervention for a given individual. And such a mistaken prioritization, for some, can become markedly counterproductive.

Rather than ‘one size fits all,’ there are specific differences between

1. The degree to which the identified experience/experiences was trauma inducing; then

2. Those who have experienced trauma;

3. Those who have been impacted by trauma;

4. Those who have become injured/debilitated by trauma; and

5. How all individually process and express the results of trauma.

Further, and of specific relevance, the very different levels of resilience and adaptation; the unique strengths, competencies and abilities by persons to more effectively respond to sometimes even horrific environmental conditions is frequently overlooked.

Trauma is also not like more traditional medical diagnoses as, for instance, asthma. While differential triggers, stressors and resources remain relevant for those with asthma...the diagnosis identifies many shared experiences, medical reactions and, even, perceptions among those who have asthma. And many others of us have a reasonably accurate understanding if told another has a severe asthmatic condition.

At the same time, how about being told that a new referral has 'experienced social/environmental trauma?' How much information with regards to the more specific etiology and experiences, true impact, Relational History and functional/adaptive response by the person or presumed treatment for the person does it offer?

As a Clinical Behavior Analyst…I’d say very little.

It is true to say that groups who have a common macro experience to include those who've lost loved ones to suicide or have survived their own attempts at suicide; experienced specific forms of severe spousal, child or sexual abuse; live with excessive ongoing community violence; combat veterans, firefighters or police officers have shared experiences. At the same time, and very unlike asthma, how those traumatic conditions manifest, impact and express across individuals is, most often, very different.

Then there must be consideration to the more traditional therapeutic approaches/frameworks. Will it prioritize a cognitive behavioral model; desensitization by reviewing the experiences; reframing towards living with and moving beyond the trauma experiences and/or education/understanding individual experiences towards self-managing/empowering and responding to recognized triggers?

And how does Clinical Behavior Analysis fit in?

Over the years, I have worked within many children and parents who have extensive trauma in their history. I've also had a lot of 1:1 success providing services to these children and their parents/caregivers directly in homes and the community. And I’ve done so using a construct framed by Clinical Behavior Analysis.

While some of those I've served have been debilitated by trauma experiences and require a more direct and collaborative approach, many others do far better when I remain aware of, include and incorporate their experiences into my treatment development; am sensitive and responsive to their experiences but don't draw upon it as a specific reference frame for services.

A key component of an approach based in Clinical Behavior Analysis is to understand individual trauma using an ecological/context-driven and functional/adaptive model.

We need to recognize and identify what are the often very logical and adaptive behavioral responses many trauma survivors – children and adults - have developed to those deeply maladaptive/dysfunctional/abnormal environments and/or conditions. In such circumstances, these behaviors can more accurately represent remarkable resilience – the incredible strength of - an individual which then must be identified, drawn out and further adapted rather than 'categorized' or otherwise (mis)labeled as ‘maladaptive.’

One example from my own clinical experiences was a four-year-old girl who, with her 2-year-old brother, had been removed from an extremely abusive, neglectful and drug addled birth home and placed with a foster family. Even as the two children started to slowly respond more positively to their new home, the foster mother reported that every day at about 3:00PM, the 4-year-old would lie on the living room couch and remain there, motionless but never sleeping, often until after dark.

The foster mom then came up with a plan. Early one evening, the foster parents and their two teenage sons announced they were ‘going to bed;’ went to their respective bedrooms and closed the doors. The foster mom waited a bit then cracked her door just a little to watch.

What she observed was that after they’d all been gone for a short while, the 4-year-old got up, looked around to be sure the adults weren’t there then went to the refrigerator to get food for herself and her 2-year-old brother. The younger boy was standing in his crib waiting to be fed by his slightly older sibling.

Without this information, the four-year-old might have otherwise appeared to be showing something easily found in the DSM. But, in fact, what happened was that this child had developed powerfully adaptive behaviors to what had been her previous intensely maladaptive and harmful circumstances.

In going motionless every afternoon, she found a way to stay physically safer then able to feed herself and her younger brother after the adults either had passed out or gone out for the night. Once she learned that not only was she absolutely safe in her new home but that she and her brother would always be able to eat; that their foster family didn't ‘run out of food,’ the identified behavior simply...disappeared.

The likelihood of powerful variables and behaviors related to Relational History (Stimulus Equivalence Theory) is also of direct relevance. This occurs when previously neutral stimuli become connected to and a part of highly problematic behavioral chains and triggers that are directly associated with the substantial trauma experiences.

Think about the same two children I’ve described above. Having adult friends/acquaintances of one’s parents/parent in the home should, at the least, be neutral/non-threatening and more often is a positive to many young children.

To the four-year-old and her younger brother, however, more adults in the home had previously hugely increased the probability of targeted physical and emotional abuse and, at the least, not having any food left to eat. Neither child, therefore, responded well to having more adults around at first.

There is no medication; no child-centered counseling model which can alone change such Relational History; these deeply established stimulus relationships and related triggering events. Instead, a priority became understanding how behavior by the little girl and her brother had been learned and shaped. Instead of taking a view of it as ‘maladaptive,’ the reality was that this child had shown remarkable adaptation, resilience and strength which included assuming responsibility for some of her younger brother's care.

Once the four-year-old learned that (1) her foster family was absolutely safe; (2) more adults in the home were not only also absolutely safe but, often, more fun for her and her brother; and (3) she and her brother would always be able to eat, the previously shaped behavior set stopped and the connected – and very negative - Relational History was ultimately neutralized.

One thing this means is that by better understanding the circumstances which drive the behavior we see along with the purpose/reason for those targeted behaviors – which can often and incorrectly appear to be acutely ‘maladaptive’ in trauma survivors - these behavioral responses can then be better neutralized and/or replaced with far more appropriate, relevant and purposeful alternatives.

Above all, an understanding that many behaviors shown by survivors of serious emotional, physical and/or environmental/social trauma are not 'maladaptive' at all but very logical responses shaped by their previously deeply illogical circumstances and environments is a key. And it is exactly such an emphasis which represents a therapeutic model framed by Clinical Behavioral Analysis.

#appliedbehavioranalysis #SocialTrauma #PTSD #ClinicalBehaviorAnalysis