Teaching Children with Autism
So much of the problematic behavior that I see in children who are receiving ABA-based treatment is best understood in terms of the relationship between the teacher and the learner. Part of that is built into ABA-based instruction itself, insofar as we are usually looking for and reinforcing some specific response to some antecedent instruction, and it is easy for students to become reluctant to respond for fear of being wrong. Another part that I want to direct your attention to is one of the ABA errors about which I have previously posted, and which I will repeat here:
Failure to recognize that essentially everything the child does in your presence is social communication
Robert Langs (The technique of psychoanalytic psychotherapy (Vols. I & 2). New York: Jason Aronson, 1973, 1974), a training psychoanalyst, observing three different communication styles in the interaction between patient and therapist during his supervision of therapists-in-training, named them Types A, B, and C.
In the Type A communicative style, the patient uses language to communicate with the therapist symbolically about his unconscious conflicts, fantasies, memories, introjects, and perceptions. The therapist in turn interprets the patient’s verbal offerings, associations, and behaviours, bringing them to the patient’s conscious attention so that the patient is in a better position to direct his or her own life (rather than have it run by his unconscious).
Types B and C were less amenable to interpretation and, thus, more of a challenge for the psychoanalyst. The Type B communicative style is characterized by the patient’s use of projective identification – the tendency to (psychologically) attribute some characteristic to the other person and then put pressure on that other person to act as if that characteristic were, in fact, his or her own – and the discharge of tensions through acting out, and the therapist’s main task is to experience and contain the patient’s interactional pressures and to translate them into cognitive understanding.
The Type C communicative style is used primarily as a barrier, for the destruction of meaningful communication, and for destruction of any real person to person interaction between patient and therapist. And if autism were primarily intrapsychically-derived – and it is more productive to think of it as a neurologically-based condition than as a psychologically-based one – Type C communication would be a prominent characteristic of the client’s communication or lack thereof.
There is a fourth communicative style which, however, is less frequently observed among psychoanalytic patients. It is what might be called straight talk, which is only possible to the extent that the individual is aware of what he/she is communicating; and individuals who can “talk straight” don’t need psychoanalysis! When we are teaching a child to communicate, it is this type of communication that we hope to eventually achieve.
Now, Langs made one other major contribution to treatment that I want to draw to your attention. He observed that it was frequently the therapist’s behaviours, and frequently his errors, which served as the primary (adaptive) context for the patient’s communications during therapy. Thus, the communications from the patient were first to be understood in terms of their here-and-now adaptive context, and frequently in terms of the reality of the interaction between the patient and therapist, and only then in terms of the patient’s internal psychopathology. This two-level approach to transference was intended to emphasize that many intrapsychically significant reactions within the patient occur in response to the therapist’s behaviours and interventions. That is, many of the regressions and symptoms within the patient are therapist evoked, being based on the therapist’s errors in intervening.
Now, why bother behaviourists with all of this “psychoanalytic junk,” as many of my colleagues would say? In my blog (posted on February 21, 2014), I noted that you may think that therapeutic interaction in the bipersonal field is only about psychoanalysis, but I want to dissuade you from that idea, since the same interpersonalprinciples apply to teaching children with autism.
In that particular posting, I also told the story of Renée, as recounted in “I Never Promised You a Rose Garden,” a semi-autobiographical novel by Joanne Greenberg (writing under the pen name of Hannah Green). Renee, the protagonist or “heroine of the story,” is a schizophrenic girl confined to a mental hospital. She observes that the patients behave more psychotically when they are around some staff than when they are around others, and she concludes that, if a staff person is secure in his or her own sanity, the patients are free to behave relatively sanely. If, however, any members of the staff are not sure of their own sanity, the patients behave psychotically so as to reassure those staff members that they are different from the patients. That is, the patients acted appropriately within the context that they are given by the staff.
As Langs has observed, “helpers” play an extremely important role in a patient’s life and, I might add, that importance starts to exert itself almost immediately after the patient becomes engaged in psychotherapy. Similarly, the importance of the instructor (therapist) in the student’s life starts to take effect almost immediately after their mutual engagement in their own bipersonal field; and everything the student does can be seen as some form of social communication! The student will communicate to the instructor the correctness of the instructor’s behaviour for the role which that instructor has assumed and, since children with autism often do not communicate verbally, the communication will often be through some other kind of behaviour, such as either (1) learning or (2) misbehaving; and instructor therapists need to learn to look for that feedback and adjust their interpersonal interactions accordingly. “Doing ABA” in the absence of a real interpersonal relationship just doesn’t cut it.