Chapter Two
Assessment
The first task in behavior modification is to specify the problems and objectives
in terms of measurable behaviors. It is not sufficient to say that a person
is neurotic. Rather, it is necessary to specify which of the person’s behaviors
should be altered and which behaviors he does not have should be added. Similarly,
it is not sufficient to choose as an educational objective
that the student develop “an appreciation of history.” Rather, it is necessary
to specify exactly what behaviors are required of the student.
The purpose of
behavioral assessment is to delineate behavioral deficits, inappropriate
behaviors, and the frequency with which different behaviors occur in various
situations. The first step is to specify the behaviors in such a way that
there is little question about whether they occurred. For example, if the
behavior modifier were interested in how afraid a person is of heights, he
might measure change in heart rate when the person is at various heights and
define fear in terms of this physiological response, or he might measure how
high up a person will go by himself. If he wanted to measure how “tidy” a child
is, he might define “tidiness” in terms of making the bed and hanging up clothes.
The point is that the assessment focuses on objective,
measurable behaviors.
Behavioral assessment
deals with behaviors and their interrelationships. It avoids mapping people
into constructs or categories that cannot be directly observed or measured,
but only indirectly inferred from some of the behaviors. If a person reports
being “generally uptight most of the time,” behavioral assessment focuses
on his behavioral strengths and deficits (including interpersonal skills,
vocational skills, thoughts, emotions, etc.) that lead to the person being
“uptight.” There is no need in behavior modification to add to this assessment
hypothesized conditions of such inferred constructs as ego-strength, self-concept,
or psycho-sexual development.
Similarly behavioral
assessment minimizes labeling or categorizing the person. The question is
what does the person do,
not what sort of person is he. Several possible problems may result from labeling a person: The practitioner
may respond to the client too much in terms of the label and thus overlook
some important behaviors or incorrectly assume the client to be similar in
some ways to someone else with the same label. Other people, such as peers,
teachers, and ward attendants may also respond and perceive the person too
much in terms of how he is labeled. The label may saddle the person with an
undesired social stigma. And if the person learns how he has been labeled,
it may cause fear and anxiety and may result in the person acting in ways
that match how he thinks a person so labeled should act (an example of self-fulfilling
prophecy). Thus labels such as “paranoid schizophrenic,” “socially maladjusted,”
and “slow learner” are generally avoided.
The way behavior
modification assessment is carried out varies dramatically with the type of
client and type of problems. It may involve sitting in the back of a classroom
recording the behaviors of various students. It may be done indirectly from
the reports of parents or teachers. It may involve measuring the amount of
litter in a campground or the number of aggressive assaults following a particular
television show. Or the assessment may be based on sampling the behavior of
patients in a mental hospital, prisoners in their cells, or people at a political
rally.
Many times the assessment
will occur in a clinical or counseling situation in which the behavior modifier
works in a one-to-one relationship with the client. Here, and in other situations,
the relationship with the client is important; although the relationship is
not seen as a necessary or sufficient condition for behavior change (see Chapter
10). Generally, it is desirable for the practitioner to have and demonstrate
genuine and non-judgmental interest and concern for the client. The optimal
practitioner is one who, as much as possible, can perceive, think, and feel
from the client’s position. From this vantage point the practitioner can draw
on his knowledge of behavior modification and suggest to the client, in terms
of the client’s mode and vocabulary of thought and perception, possible courses
of action to deal with the problems. The relationship with the client may
facilitate such things as gaining accurate information, motivating the client,
and setting up a program geared toward where the client psychologically is
at the present. Thus behavior modifiers who
work in such situations may often benefit from training in interpersonal and
counseling skills.
Information for a
behavioral assessment may come from a wide variety of sources, including direct
observation of the client, as a student in a classroom or worker in a plant;
self-report of the client, as in a counseling interview situation;
role-playing, as when the practitioner assumes the part of the client’s mother
and with the client they role-play a recent interaction between the client and
the client’s mother; and physiological measures, such as measuring the amount
of change in heart rate when the client imagines different fearful situations.
Information may also be obtained from the client’s peers, teachers, parents,
doctor, or boss.
The client may be
asked to write a brief autobiography or fill out a life history questionnaire
(e.g., Lazarus, 1971, appendix A). Children may be asked what three wishes
they would make in terms of changing things about their lives.
One of the best sources
of information is to have the client keep a personal log or diary related
to specific problems. A person with a lot of anxiety may keep a log including
an exact description of each situation which made him anxious, how he responded
in this situation, and what was the result of how he responded. Parents might
keep a diary of their child’s behavior, including the situations, how the
child behaved, and how they and others then responded to the child. The clients
themselves often learn much about their own behavior through such procedures,
and this “know thyself” is often the first step toward self-improvement and
self-control.
Numerous tests and questionnaires have been devised to aid behavioral assessment. The following is a sample. There are several variations of the Fear Survey Schedule (Geer, 1965; Wolpe & Lang, 1964) in which the client is given a long list of items (e.g., falling, automobiles, and dentists) and asked to indicate on a five-point scale the degree to which each item disturbs him. The answers are used to help determine situations that elicit anxiety. Suinn (.1 969) has developed a similar instrument to assess anxiety related to examination situations, test anxiety. The Reinforcement Survey Schedule (Cautela, 1 972; Cautela & Kastenbaum, 1 967) helps determine what situations, objects, and activities are pleasing or rewarding for the client. This includes things to eat, types of reading, music, sports, general activities, praiser and types of interactions with others. This information may be used to help establish rapport with the client (e.g., topics to talk about) and for specific programs, such as counterconditioning (Chapter 3) or operant conditioning (Chapter 7). A variation of this questionnaire has been developed specifically for children (Keat, 1974). Many assertive questionnaires have been developed to determine how non-assertive, assertive, or aggressive people are in various situations (e.g., Galassi et al., 1974; Gambrill & Richey, 1975; Gay et al., 1975; Rathus, 1973). These include how people respond in situations such as people pushing in front of them in a line or receiving an overdone steak in a restaurant. They help identify people who are over-apologetic, shy about dates, have trouble being open or frank, or have a hard time refusing unreasonable requests or generally just saying no. Such people often profit from assertive training (Chapter 8). The Marital Pre-Counseling Inventory (Stuart & Stuart, 1973) is a questionnaire completed by clients prior to beginning marriage counseling. This includes ways they get along and interact, likes and dislikes, goals, how time is spent, resources, interests, decision making, ways of communicating, sexual behavior, and ways of managing the children. A similar questionnaire for family counseling, the Family Pre-Counseling Inventory
(Stuart & Stuart,
1975), has separate forms for adolescents, father, and mother, It covers similar
topics as the marital inventory, as well as interactions among family members
and perceptions of self and others.
The practitioner
must be careful not to assign too much validity to the responses to questionnaires
or tests, either those mentioned in this text or any others. Rather, the results
should be perceived as more behavior, information, and sources of ideas and
hypotheses to be pursued, qualified, and correlated with other behavior. For
a client may understand a question differently from what a practitioner expects
or mean something different by an answer than the practitioner would infer.
There is also room for many cultural, social, age, and sex biases. For example,
men often indicate less anxiety on the Fear Survey Schedule than women. This
may be because they experience less anxiety and/or simply report it as less.
Information of this
sort is used to determine what
in the present affects the client’s behaviors. What stimuli or situations
elicit behaviors or make more probable certain behaviors will occur? What
are the results or consequences of these behaviors? How do the various behaviors
interrelate? What are the learning contingencies that are operative? What
are the basic behavioral excesses and deficits?
All behavior or problems
are broken down into component behaviors that are clearly defined and measurable.
If a person reports being generally depressed, we do not have a standard treatment
for depression. Rather, treatment depends on the behavioral assessment that
may indicate the person receives inadequate reward from work, feels anxious
in social situations, or gets taken advantage of easily.
Behaviors are defined
in terms of how they are measured, objective descriptions that others can
observe and verify. Rather than calling a child hyperactive, we may speak
of how many times he leaves his seat during a class period. Ayllon and Azrin
(1968b, p. 44) describe a case in which a social worker concluded on the basis
of an interview that a female mental patient was incapable of independent
functioning. Yet behavioral records from the ward showed the patient regularly
bathed herself, brushed her teeth, dressed herself, made her bed, and worked
six hours per day without disrupting others. What did the social worker mean
by “independent functioning?” It would have been better if the social worker
had stated the assessment in terms of measured behaviors.
A general issue is
that it is often possible to change one set of behaviors without changing
another set, even though they seem related or seem to be measures of a common
problem. Fear, for example, may be measured by verbal report, approach-avoidance
behavior (how close the
client will go to the feared situation), and
physiological measures. These behavioral measures of fear are relatively independent,
and one can be altered without changing the others (Hodgson & Rachman,
1974; Rachman & Hodgson, 1974). Thus a person may report no longer being
fearful of snakes, but refuse to get any closer to them. Or a person may handle
a snake with no physiological increase in arousal, yet report still being
afraid of snakes.
Realizing the independence
of different behaviors, the practitioner should use a variety of different
behavioral measures and be cautious about over-generalizing from one measure.
This is particularly true of the client’s verbal report, which can be easily
altered without there being any other behavioral change. Rewarding a person
for reporting changes in problematic behaviors may only be affecting the verbal
behavior of reporting changes, when, in fact, such changes may not be taking
place or are taking place to a lesser degree than reported. Verbal report
is often biased by the client’s attempt to maintain some image or please the
practitioner.
It generally is desirable
to measure the frequency with which the behavior to be modified occurs in
different situations. With smoking, for example, the behavior modifier would
want to know how much the person smokes in situations such as cocktail parties
and after dinner. Such data provide baselines (relatively steady rates
of behavior) that can be used later to judge the effectiveness of the modification
procedure. The frequencies also provide information about which contexts or
problems should receive the major emphasis and what would be a reasonable
first step in the change program. Getting objective measures of the frequencies
of behaviors may also reduce misperceptions. Without counting, a teacher may
over-estimate how often a particular behavior occurs in a classroom, because
the behavior is one he particularly dislikes. Without counting, a person may
underestimate the amount of alcohol he consumes each week. In time-sampling
the frequency of a behavior is recorded during short intervals at various
times. This way, we can occasionally measure a frequent behavior, rather than
keep track of every time it occurs. Time-sampling also facilitates keeping
information on a large number of people at one time, as in a classroom or
hospital ward, as we can just sample each person’s behavior at different times.
Often clients are
asked to keep counts on their own behavior, a process called self-monitoring.
This may be done using graphs, checklists, or marks in a pocket notebook.
For example, a person may weigh himself each morning and put this on a graph
on the refrigerator door. A popular self- monitoring device is a wristcounter,
such as golfers use. This counter, worn like a wristwatch, can be used to
count each occurrence of a behavior such as smoking a cigarette, pulling a
beard, biting a fingernail, or thinking a self-depreciating thought. Sometimes
self-monitoring is sufficient for some behavior change, although often it is not, for self-monitoring makes the person more aware of doing the behavior,
a good first step to self-control. If this awareness is coupled with a dissatisfaction
of the frequency the behavior is occurring plus the ability to change the
frequency, then behavior change may result. Thus Maletzky (1974) was able
to produce dramatic behavioral changes in a variety of behaviors (e.g., repetitive
scratching, fingernail-biting, facial tics) by having the people count the
behaviors using wristcounters and graph the frequencies and progress. Rozensky
(1974) reported a greater effect on reducing cigarette smoking if the person
recorded the cigarette before smoking rather than after. Thus self-monitoring
is a useful assessment procedure, which may produce some behavioral change.
In those cases where insufficient change results from the monitoring, we add
the appropriate behavior modification program.
Kanfer and Saslow
(1969) offer a diagnostic outline which consists of seven major components:
|
1.
|
INITIAL
ANALYSIS OF THE PROBLEM SITUATION. |
| Determine
(a)which behaviors are considered problematic because they occur in excess
in frequency, intensity, or duration; (b) which behaviors are considered
problematic because they fail to occur with sufficient frequency, adequate
intensity, or appropriate form; and (c) which behaviors the patient can
do particularly well. |
|
2.
|
CLARIFICATION
OF THE PROBLEM SITUATION. |
| Next, put the various behaviors into a more global picture by specifying the situations in which they occur, the consequences of the behaviors, and the probable effects of changing the behaviors. |
|
3.
|
MOTIVATIONAL
ANALYSIS. |
| Specify
the events that are rewarding and punishing to the client and their effects
in different situations. |
|
4.
|
DEVELOPMENTAL
ANALYSIS. |
| Delineate
the effects of any physiological limitations of the client, the effects
of the client’s current sociocultural milieu and any past changes in this
milieu, and earlier behavioral problems. |
|
5.
|
ANALYSIS
OF SELF-CONTROL. |
| can
control and in which situations. Determine what behaviors the client |
|
6.
|
ANALYSIS
OF SOCIAL RELATIONSHIPS. |
| Specify what people the client interacts with, how he behaves toward them, and how they behave toward him. |
|
7.
|
ANALYSIS
OF THE SOCIAL-CULTURAL-PHYSICAL ENVIRONMENT. |
| Analyze the client’s environments in terms of the norms and the limitations they put on the client. |
In a behavior
modification program it is necessary to objectively specify the target behaviors,
the terminal behaviors that are to be produced for different conditions. It
is not sufficient, and it is ambiguous, for a clinician to say that his goal is
“self-actualization” or “reorganization of self.” The clinician must describe
what behaviors the client would have to demonstrate for the clinician to
attribute to the client something like self-actualization. Once the behaviors
have been specified, it is much easier to decide on the procedures to produce
the target behaviors, as well as to know when the goal has been achieved.
Similarly, it is
a poor educational objective to say the terminal behavior is to be a “good
understanding of algebra.” Rather, the educator should specify exactly what
behavior he wants—for example, being able to solve quadratic equations and
to graph any linear equation. Mager (1962, p. 53) gives the following summary
for preparing instructional objectives:
|
1.
|
A
statement of instructional objectives is a collection of words or symbols
describing one of your educational intents. |
|
|
2.
|
An
objective will communicate your intent to the degree you have described
what the learner will be DOING when demonstrating his achievement and
how you will know when he is doing it. |
|
|
3.
|
To
describe terminal behavior (what the learner will be DOING): |
|
| a. | Identify
and name the over-all behavior act. |
|
| b. | Define
the important conditions under which the behavior is to occur(givens or
restrictions, or both). |
|
| c. | Define
the criterion of acceptable performance. |
|
|
4.
|
Write
a separate statement for each objective; the more statements you have,
the better chance you have of making clear your intent. |
|
|
5.
|
If
you give each learner a copy of your objectives, you may not have to do
much else. |
|
The behavioral
objectives should generally be stated in small, progressive steps—sequences of
immediate goals on the way to long-range objectives. The target behavior for a
nursery schoolboy may be for him to be “social”—that is, spend more of his time
playing with others. The immediate goals may be a sequence such as (1) the boy
watching the others playing games, (2) the boy playing for five minutes with
another child, (3) the boy playing for ten minutes with another child, (4) the
boy playing for ten minutes with more than one other child, and so forth. By
taking small steps the behavior can be gradually changed and the amount of
failure minimized, for the practitioner becomes quickly aware of any necessary
changes in procedure.
All change agents,
regardless of their theoretical model, are faced with a wide range of ethical
questions. Choosing not to work with a client is an ethical issue. Choosing to
minimize your influence on a client, and thus give greater weight to other
sources of influence, is an ethical issue. Choosing a model or approach that
does not deal with your influence as a change agent is an ethical issue.
The choice of terminal
behaviors necessarily involves value judgments. Why is one target behavior
chosen over another? Why is it better for the child to be social than non-social?
Similarly, the choice of procedures to reach a goal often involves ethical
issues. For example, if a person is an alcoholic who can be helped, but the
treatment is unpleasant, such as aversive counterconditioning where electric
shock might be paired with drinking (see Chapter 6), to what extent do the
results of treatment justify the treatment procedures?
Basically, behavior
modification does not specify a moral system. It is an amoral, not immoral,
technology. It is concerned with variables affecting behavior change independent
of the ethical issues that arise at various decision points. A strength of
behavior modification is that it specifies its procedures and goals and thus
clarifies and spotlights the ethical issues that must be confronted. Many
behavior modifiers (e.g., Begelman, 1975; Davison & Stuart, 1975; Stuart,
1975) are raising and discussing a variety of ethical issues related to behavior
modification practice. My personal bias is that at this level I cannot rationally
defend any particular ethical system, but rather choose to emphasize the importance
of being aware of the range of ethical Issues that must be confronted.
The field of learning
and motivation not only deals with behavior Change once certain ethical decisions
are made, but it is also concerned With how a person acquires a particular
ethical system and how this affects his ethical behavior and decisions. This
makes the discussion of ethical choices even more complex, for it carries
us into the study of the influences on behavior that occur prior to the point
we may have arbitrarily placed the ethical decision. Discussions of ethics
are often controversial; but discussion of how a person may come to acquire
certain ethical positions (e.g., Skinner, 1971) is often more threatening
and controversial.
In practice, ethical
decisions are made all along the way, perhaps according to some cultural or
personal norms or some idea of how to help the client become happier or more
fulfilled. The client can often be involved in the decisions about goals and
procedures. Or the pratitioner may emphasize self-control and giving the client
more skills, alternatives, and some sense of freedom. Finally, it is important
to always keep in mind that although we may talk about undesirable behavior,
meaning undesirable in terms of some ethical system, we do not want to
go past there and talk about an undesirable person.
One important ethical
issue that often arises is to what extent do you change a person to match
a situation and to what extent do you change the situation. For example, in
some cases it may be better to change the classroom materials and curriculum
than to use behavior modification to increase the students’ motivation in
the existing system. In the last couple of years there have been a couple
of poor programs, unfortunately called behavior modification, that were set
up in prisons to coerce the prisoners into obeying the existing prison system,
when actually the prison system needed to be changed. On the other hand, many
cases exist in which the situation cannot be changed and/or it seems desirable
to primarily change the person’s behavior to the situation.
Another ethical issue
that has been popular in behavior modification in the last few years concerns
the treatment of homosexuality. Some people in our culture perceive homosexuals
as deviants who need to be changed for their own good and the good of society.
Some behavior therapists respond that they will only treat homosexuals who
wish to change. Other behavior therapists, however, argue that in our culture
there is such strong social prejudice and conditioning against homosexuality,
that there is little free choice about being a homosexual or not, even if
the client feels there is. Thus these practitioners prefer not to help a person
change from being a homosexual, but prefer to help the person adjust better
to being a homosexual (e.g., Davison, 1976). My bias is to try to remain aware
of these arguments and the subtleties involved and consider each case individually.
Thus the choice of
the goals for a behavior change program is sometimes more complex than it
first seems. One must carefully consider the many implications of producing
any behavior change, in terms of the person, the culture, and the related
ethics. And of course, sometimes you run across things you did not consider.
For example, one program (Goldstein, 1974) involved a counselor trying to
increase “paying attention” in school in a Navajo child. The counselor began
with trying to increase eye contact, a common first step in similar programs.
But the child began running away from school. A probable reason for this is
that in the Navajo creation account there is a terrible monster called He-Who-Kills-With-His-Eyes.
So children learn to avert their eyes to avoid bringing harm to others;
and in this culture a stare implies sexual or aggressive assault.
Behavioral assessment
involves specifying the problem in terms of behaviors, including behavioral
deficits and excesses. The behaviors are defined, as much as possible, in ways
that are readily observed and measured, being careful not to rely too heavily
on any one measure, particularly verbal report. Assessment involves determining
the frequencies with which
behaviors occur in various situations, the consequences of the
behaviors, and interrelationships among behaviors. Information for assessment
comes from such possible sources as observation of the client, self-report of
the client (including written
reports such as assessment tests and daily logs), role-playing, physiological
measures, and reports from other people who know the client. Similarly, goals
of the change program are specified, as much as possible, in terms of measurable behaviors, often involving a
sequence of intermediate steps leading to the final terminal behaviors. Ethical
issues must be recognized all along the way from choosing whether to deal with
a problem, to the choice of goals, to the choice of change procedures.
|
1.
|
If
as a clinician a client spoke of being generally depressed and feeling
as a social misfit, what assessment procedures might you employ to behaviorally
delineate the exact nature of the problem? What would be one possible
example of a behavioral specification of this problem? |
|
2.
|
If as a school counselor a teacher reports that the students in his fourth grade classroom are too unruly, what procedures would you use to behaviorally assess this problem? Give examples of possible behavior problems you might discover. |
|
3.
|
Consider
your answers to the first two questions. What would be examples of good
behavioral objectives for each of these problem areas? Give sequences
of steps leading to each goal. |
|
4.
|
Practice
self-monitoring one of your behaviors for a few days. What did you learn?
To what extent and in what way do you deceive yourself in the situations
you monitored? Did the monitoring affect the frequency of the behavior?
Why? What suggestions can you make to someone who will try self-monitoring? |
|
5.
|
To
what extent can you interact with people without categorizing them in
some sense? Spend a day trying not to label or judge people. What did
you learn from this? What are the practical implications of what you learned?
For a very hard exercise, try spending a day in which you have no opinions about anything. |
|
6.
|
How
reliable is a client’s verbal report? What could be done to make it more
reliable? |
|
7.
|
In
a clinical setting where the practitioner works one-to-one with a client,
what are important or useful properties of the counseling relationship?
Express your answers in terms of well-defined measurable behaviors. |
|
8.
|
What
is the best way for you to remain aware of the range of ethical issues
you must consider in any change program? |
|
9.
|
Consider
the various points of view discussed in the text about working with homosexuals.
What is your position? Why? What if the client were 35? 20? 15? 10? What
difference does it make if the client is male or female? Why? |
|
10.
|
How do you as a parent raise your children to do well in a culture that,
from your ethical system, is different from what it should be? |
Cautela, J. R. Behavior
analysis forms for clinical intervention. Champaign, Ill.:
Research Press, 1977.
Ciminero, A. R.,
Calhoun, K. S., & Adams, H. F. (eds.) Handbook of behavioral assessment.
New York: Wiley, 1977.
Goldfried, M. R.
& Kent, R. N. Traditional versus behavioral personality assessment:
A comparison of
methodological and theoretical assumptions. Psychological Bulletin, 1972,
77, 409—420.
Goldfried, M. R.
& Sprafkin, J. N. Behavioral personality assessment. Morristown, N.J.:
General Learning Press, 1974.
Hersen, M. &
Bellack, A. S. (eds.). Behavioral assessment: A practical handbook. Elmsford,
N.Y.: Pergamon Press, 1976.
Mager, R. F. Goal
analysis. Belmont, Calif.: Fearon Publishers, 1972.
Mager, R. F. Preparing
instructional objectives. Belmont, Calif.: Fearon Publishers, 1962.
Mash, F. J. & Terdal, L. G. (eds.). Behavior-therapy assessment. New York:
Springer, 1976.
Thomas, E. J. (ed.). Behavior
modification procedure: A sourcebook. Chicago: Aldine, 1974.
Wolpe, J. Theme and variations: A behavior therapy casebook. Elmsford, N.Y.: Pergamon Press, 1976. Section III.