Bettelheim and Skinner in Modern Therapy

1. Bettelheim and Skinner in Modern Therapy Jenny Kautzky Matt Merkl Mary Hulseman

2. Autism • 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”

4. Bettelheim (1903-1990)

5. Bettelheim Biography • 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

6. Liberation of Buchenwald

7. Bettelheim: the Root of Autism • 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)

8. Bettelheim on Therapy • 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

9. Bettelheim on the Individual • “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)

10. Orthogenic School in Chicago • 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

11. Orthogenic School in Chicago

12. Skinner (1904-1990)

13. Skinner Biography • 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

14. Skinner on Behavior • 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)

15. Hypothesis • 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.

16. Application in Modern Therapy • 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

17. “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)

18. “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/)

19. 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 self- to gain a sense of well-being.” (The Empty Fortress; Infantile Autism and the Birth of the Self) • Skinner: • “We change behavior toward something, not an attitude toward it.” (Beyond Freedom and Dignity) Bettelheim 1 2 3 4 5 6 Skinner

20. Data Collected • Is therapy more child-centered or therapist-directed? • 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

21. Results • 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)

22. Skinner in Therapy • ECI: Repetition of directions Constant feedback/ encouragement Worked from simple to complex tasks • 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)

23. Bettelheim in Therapy • ECI: Approached each child as an individual with needs and a particular way of learning Child-centered philosophy • Baylor OCH: Routine Institution outside of home (without parents) Child-centered philosophy

24. Evaluation • Baylor OCH has elements of Bettelheim, namely the focus on the individual and especially approaching therapy from a “child-centered” 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.

25. Evaluation • 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.

26. Evolution in Therapy Change in quality of institutions and quicker diagnosis of autism More financial support for treatment Technological advances such as therapeutic listening

27. Autism Today • Dr. Temple Grandin who suffers from high functioning autism wrote a book that changed the way people view autism • (written in 1995)