Friday, January 1, 2016

Implementation and Significance: Fundamental Psychotherapeutic Interventions

Implementation and Significance: Fundamental Psychotherapeutic Interventions

Promise them anything, but give them behavior potential. Peter Ossorio

Near the start of my training analysis I realized that my mostly silent analyst, seated behind me, wrote with a scratchy pencil. Evidently not everything I said warranted noting but apparently some things did. “Operant conditioning”, I commented.  Just the sort of remark to irritate a classical analyst, “I know what holds your attention.” Wanting his interest, the scratch from behind was all the reward I needed to produce more of the same.  But more of the same what?  is what I want to examine. No surprise, he soon switched to a silent pen.

The premise of operant conditioning or instrumental learning is that reward or punishment following a behavior will increase or decrease the behavior's frequency. Thorndike and Skinner taught this. We can teach pigeons and dogs tricks with this sort of reinforcement.  In animals with a limited behavior repertory, this sort of training tends to increase or decrease a specific performance.  Rumor has it this works with infants and young children, but not all that well.

When operant conditioning is applied to socially complex animals with few routinized or stereotypical behaviors, what often follows is not an exact reproduction of the conditioned behavior but variations on a theme, kindred behaviors with shared significance. I think this was first observed in dolphins, who when rewarded for doing something they'd not previously done, responded with novelty.   

But what did I produce in response to my analyst’s sounds? No dummy, I didn’t simply reproduce my previous comments, nor did I try to figure out another way to say the same thing; instead I began to understand the concerns and meanings he thought were significant. 

I’m a psychotherapist, not so interested in training cats and dogs. (I know from experience they seem to make up their own minds how they’ll respond to any sort of "conditioning".) What interests me is helping people with what they identify as problematic and unsatisfying. Accordingly, I spend a lot of time wondering about the effectiveness of a person's way of relating and the significance of what they are trying to accomplish. Something probably needs to change.  

So when a person describes or illustrates a problematic behavior, I might ask, "How’s doing it that way working for you?" Or, "What difference does it really make? What's at stake?"  The first focuses on performance or implementation and the second attends to meaning or significance.  Inquiry regarding how something is working leads to questions about alternatives that might work better. And how something matters brings up questions of what might matter more or might conflict, now or in the long run. Does it really matter that much when you also consider the other things that do?  These questions are in the service of increasing a person’s range of effective action.

Psychotherapy, as I see it, should enhance a person's potential for flexible, improvisational responses to challenging circumstances. My job involves helping people increase their ease in changing action patterns performed with inadequate knowledge or skill, or absent an adequate appreciation of implication and significance. My intent is to invite reflection and discussion of alternatives and significances. The conversation itself should provide practice in doing something different and new.

All the relational features of good psychotherapy provide the context of intervention, but at the end of the day people need to do things differently. Every intentional action, conscious or unconscious, involves a person trying to achieve something in a particular manner that carries significance to themselves and others. Asking people if it might work better done differently, and asking if the significance of what they are attempting best serves their overall interests, are good questions to pose. When stuck, try them out. Like with our aquatic cousins, the dolphins, something new and better might follow. 

A related entry on uncertainty and the policies of effective psychotherapy: Mindful Uncertainty: What is Psychotherapy?

A person's behavior is largely organized by what they find significant. People generally notice opportunities to implement what matters to them. The Descriptive Psychological concept of "through-lines" identifies these "in-character" patterns:  Through-Lines and the Dramaturgical Pattern.