Download Bettelheim and Skinner in Modern Therapy

Jenny Kautzky
Matt Merkl
Mary Hulseman
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Autism: a developmental disorder that is
characterized by the impairment of the ability
to communicate with others
Bettelheim believed that “although autistic
children are solipsistic as infants in their
contact with reality, and communicate as
little, they are much farther developed in
body”
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Interested in psychology but earned his degree
in philosophy at the University of Vienna
A Jew living in Austria, he spent 11 months in
concentration camps then was released
Married and went to the U.S. where he became
a professor of psychology
Director of the Orthogenic School in Chicago,
where he housed and treated many cognitively
impaired children
Suffered from depression and ultimately
committed suicide after his wife died
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He believed that “the lack of satisfying
responses from those who take care of him
may force the infant too early to view the
world as purely frustrating.. [this view] will
not impel him to invest vital energy in
reaching out for what he wants, even when
his growth development makes that possible”
(The Empty Fortress)
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Encouraged the counselors to conduct
‘marginal interviews’ with the children in
which the counselor clears up any anxiety
that the child has in order for them to
participate
Interpretative character; did not interfere with
the activity of the child
Ego-supporting
“therapeutic effort, taken singly or added up,
cannot easily achieve what is done through
the integrated efforts of a total staff; but the
condition for such work is a pattern of group
living that is harmoniously concerted without
any single voice losing its independent
character.. The individual uniqueness must be
preserved within the unity of living if any
success is to be achieved”
(Love is Not Enough)
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Aimed at “eventually giving the child the feeling
that we believe that neither he alone nor we
alone can solve his basic problems, but that he
will be able to solve them with our help in a
process of daily living together” (Love is Not
Enough)
Avoid any efforts to discuss the child’s problems;
allows the child to rely on actual daily activities
he can participate in or watch in order to make
his own judgments of the school
Different attitude towards money and activities
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Born in Pennsylvania and attended Hamilton
College (where he worked in the lab of an
experimental biologist) and Harvard
University
Using pigeons and rats he developed his
notions of “operant conditioning” and
“shaping behavior”
Taught at Harvard while he published several
books such as Science and Human Behavior
and Beyond Freedom and Dignity; he died in
1990
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Gives a scientific analysis which shifts both
the responsibility and the achievement to the
environment
“Operant” behavior
Negative/positive reinforcements and
punishments
“Our task is not to encourage moral struggle
or to build or demonstrate inner virtues. It is
to make life less punishing” (Beyond Freedom
and Dignity)
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We hypothesized that there would be some of
Bettelheim’s notions of the importance of the
individual in therapy, but that the treatment
would deviate from Bettelheim’s
developmental approach in that the
therapists incorporate some elements of
behavior modification rooted in Skinner.
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We wanted to look at the implications of
Bettelheim and Skinner’s work in modern
therapy practices. We observed PTs and OTs
at Baylor OCH as well as ECI in order to
collect data.
Baylor OCH is an outpatient clinic; ECI is an in
home therapy program
“Our Children’s House at Baylor is a
licensed pediatric hospital where
care is comprehensive and healing is
fun. Here, children from infancy
through age 18 receive care for
developmental or birth disorders,
traumatic injury and severe illness.
OCH at Baylor offers specialized
pediatric therapy at our nine
outpatient therapy clinics located
across the DFW Metroplex.”
(http://Baylorhealth.com)
“ECI is a statewide program for families with
children, birth to three, with disabilities and
developmental delays. ECI supports families
to help their children reach their potential
through developmental services. Services are
provided by a variety of local agencies and
organizations across Texas.”
(http://www.dars.state.tx.us/ecis/)
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1) Is therapy more child-centered or therapist-directed?
Bettelheim:
“They have to protect as their own, by not beginning to “do” when we would like
them to, but only in their own good time.”
(The Empty Fortress; Infantile Autism and the Birth of the Self)
Skinner:
“To refuse to control is to leave control not to the person himself, but to other parts
of the social and non-social environments.”
(Beyond Freedom and Dignity)
2) Does the therapist let the session play out regardless of the child’s
behavior or try to change the behavior using their actions or words?
Bettelheim:
“They have to make sure innumerable times that nothing is being forced on them,
that it is they who want to eat, to move their bowels, to play or do anything,
including talk.” (The Empty Fortress; Infantile Autism and the Birth of the Self)
Skinner:
“Guidance is effective, however, only to the extent that control is exerted. To guide
is either to open new opportunities or to block growth in particular directions.”
(Beyond Freedom and Dignity)
3) Regarding the interaction between the therapist and patient, is there an
effort to change the attitude of the patient or merely the behavior?
Bettelheim:
“Only after a period of soiling or not dressing themselves do they relearn such a
skill, but now within a more positive relationship and as part of a developing selfto gain a sense of well-being.” (The Empty Fortress; Infantile Autism and the Birth of
the Self)
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Skinner:
“We change behavior toward something, not an attitude toward
it.” (Beyond Freedom and Dignity)
Bettelheim 1
2
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4
5
6 Skinner
1)
2)
3)
Patient 1
(10 yr M)
Patient 2
(10 yr M)
Patient 3
(18 mon M)
Patient 4 (3
yrs F)
Q1:
2
2
5
5
Q2:
5
4
5
5
Q3:
5
4
3
5
Is therapy more child-centered or therapistdirected?
Does the therapist let the session play out
regardless of the child’s behavior or try to
change the behavior using their actions/ words?
Regarding the interaction between the therapist
and patient, is there an effort to change the
attitude of the patient or merely the behavior?
Bettelheim 1
2
3
4
5
6 Skinner
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Most sessions did tend to be child-centered, but
depends on the therapist.
Therapists tended to try to change the behavior
of the child, often with different techniques
(positive reinforcement/tone/body language etc).
Child’s attitude varied each session depending
on how their day was going
Most therapists tried to just change behavior and
not attitude but with the youngest child (Patient
3), the therapist had to change his attitude to get
any work done (he was on the verge of crying)
Baylor OCH:
Use of positive
reinforcement- Wii
Lower tone (sensitive
hearing) attempt to
keep child “on track”
Repetition of directions
Outside tools to change
comfort level, rather
than just letting them
interact & change on
their own(as in
Bettelheim’s school)
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ECI:
Repetition of
directions
Constant feedback/
encouragement
Worked from simple
to complex tasks
Baylor OCH:
Routine
Institution outside of
home (without
parents)
Child-centered
philosophy
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ECI:
Approached each
child as an
individual with
needs and a
particular way of
learning
Child-centered
philosophy
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Baylor OCH has elements of Bettelheim,
namely the focus on the individual and
especially approaching therapy from a “childcentered” perspective in an outpatient clinic.
Baylor OCH therapists tended to use a
rewards system, especially positive
reinforcement, in order to modify the
behavior of the patients, and this reflected
Skinner’s beliefs.
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ECI also uses a child-centered approach in a
home environment in which parents can
freely interact and learn more about how to
help improve the development of their child
between the weekly sessions. ECI uses a lot
of repetition and positive encouragement,
without using any forceful tactics or
attempting to control the patient.
Change in quality of institutions and quicker
diagnosis of autism
More financial support for treatment
Technological advances such as therapeutic
listening
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Dr. Temple Grandin
who suffers from high
functioning autism
wrote a book that
changed the way
people view autism
(written in 1995)