UBC Theses and Dissertations

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UBC Theses and Dissertations

A model for working with dysfunctional blue collar families Nickerson, William James Murdoch 1978

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A MODEL FOR WORKING WITH DYSFUNCTIONAL BLUE COLLAR FAMILIES J by WILLIAM JAMES MURDOCH NICKERSON B.A. (Psychology) U n i v e r s i t y o f B r i t i s h Columbia, 1976 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE FACULTY OF GRADUATE STUDIES C o u n s e l l i n g Psychology We accept t h i s t h e s i s as conforming to the r e q u i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA December, 19 78 W i l l i a m James Murdoch Ni c k e r s o n , 1978 I n p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f the requirements for an a d v a n c e d d e g r e e a t t h e U n i v e r s i t y of B r i t i s h Columbia, I agree that t h e L i b r a r y s h a l l m a k e i t f r e e l y a v a i l a b l e f o r reference and study. I f u r t h e r a g r e e t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g of t h i s t h e s i s for s c h o l a r l y p u r p o s e s may b e g r a n t e d b y t h e Head of my Department or by h i s r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t copying or pub l i ca t ion of t h i s t h e s i s for f i n a n c i a l g a i n s h a l l n o t be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . Department of T h e U n i v e r s i t y of B r i t i s h C o l u m b i a 2075 Wesbrook Place Vancouver, Canada V6T 1W5 A b s t r a c t The c e n t r a l purpose of t h i s t h e s i s was the development o f a model of i n t e r v e n t i o n with the d y s f u n c t i o n a l blue c o l l a r fam-i l y . The o v e r a l l d i s c u s s i o n focused on two i s s u e s . The f i r s t i n v o l v e d the d e l i n e a t i o n o f a method of treatment f o r the b l u e c o l l a r f a m i l y . A s p e c i f i c approach was determined through an examination of some of the c h a r a c t e r i s t i c s of the blue c o l l a r f a m i l y . The second major area o f d i s c u s s i o n centered on the combination or p a i r i n g of two d i v e r g e n t p s y c h o l o g i c a l approaches to compliment the proposed treatment s t y l e . The Rogerian approach and a behavior m o d i f i c a t i o n approach were examined and the ad-vantages of each as an o v e r a l l treatment method were u t i l i z e d i n the proposed model. The sources o f i n f o r m a t i o n f o r the study came from p e r s o n a l c l i n i c a l experience i n working w i t h blue c o l l a r f a m i l i e s and from a review o f c u r r e n t r e l e v a n t l i t e r a t u r e . The l i t e r a t u r e reviewed covered f o u r main s u b j e c t areas: a) a s o c i a l l e a r n i n g o r behavior m o d i f i c a t i o n approach, b) the use o f parents as change agents f o r t h e i r c h i l d r e n , c) the Rogerian t h e r a p e u t i c r e l a t i o n s h i p , and d) some c h a r a c t e r i s t i c s o f the blue c o l l a r f a m i l y . The review o f the l i t e r a t u r e and p e r s o n a l c l i n i c a l e x p e r i -ence r e s u l t e d i n a proposed treatment model f o r t h e r a p e u t i c i n -t e r v e n t i o n w i t h the blue c o l l a r f a m i l y . The model c o n t a i n s s i x components which come under three main headings. They are: i i i A. Assessment A l . R o l e - I n d u c t i o n Interview A2. Intake Interview A3. B a s e l i n e B. Treatment B l . Parent T r a i n i n g Sessions B2. Assessment of Change C. E v a l u a t i o n C l . C o n s u l t a t i v e Follow-Up Some I m p l i c a t i o n s f o r f u r t h e r r e s e a r c h r e g a r d i n g the model presented i n c l u d e a comparison of the proposed model w i t h o t h e r models o f f a m i l y i n t e r v e n t i o n . I n v e s t i g a t i o n o f the dynamics o f the r e l a t i o n s h i p between the t h e r a p i s t and the parent and/or the parent and the c h i l d might a l s o r e s u l t i n c o n t r i b u t i o n s to the f i e l d of f a m i l y therapy. i v TABLE OF CONTENTS Page Chapter 1, I n t r o d u c t i o n to the Study 1 I n t r o d u c t i o n 1 Statement o f the Problem 3 O b j e c t i v e s 3 C o n t r i b u t i o n s o f the Study 4 D e f i n i t i o n o f Terms 5 L i m i t a t i o n s o f the Study 7 Overview of the Study 8 Chapter I I , Review of the L i t e r a t u r e 9 Overview 9 I n t r o d u c t i o n t o ' S o c i a l L e a r n i n g Theory 11 Reinforcement Theory 12 Comparison of S o c i a l L e a r n i n g Theory w i t h Other Psychotherapies 13 Ps y c h o a n a l y s i s 13 A d l e r i a n Psychology 14 C l i e n t - c e n t e r e d Therapy 14 E v a l u a t i o n of the S o c i a l L earning Approach 16 Disadvantages 16 Advantages 17 D e f i n i t i o n o f B e h a v i o r a l Terms 19 Contingency management 19 Contingency manager 19 E x t i n c t i o n 19 V Page Fading 19 Mediator 19 P o s i t i v e r e i n f o r c e r s 2 0 Time-out 2 0 Use of Parents as P s y c h o t h e r a p e u t i c Agents 20 T r a i n i n g Parents i n Operant Techniques - Background 22 Blue C o l l a r Family 24 C h a r a c t e r i s t i c s o f the Blue C o l l a r Family 25 Blue C o l l a r Family - Method o f Treatment 2 8 A S p e c i f i c Treatment Approach 30 The Blue C o l l a r Family and a Behavior M o d i f i c a t i o n Approach 31 Chapter I I I , The Model 34 I n t r o d u c t i o n 34 The T h e r a p e u t i c R e l a t i o n s h i p 35 Combining Behavior Therapy and Aspects o f the T h e r a p e u t i c R e l a t i o n s h i p . 3 8 A Proposed A l t e r n a t e Treatment Model 40 I n t r o d u c t i o n 40 A. Assessment • 42 A l . R o l e - I n d u c t i o n Interview 4 2 A2. Intake Interview 44 Breakage Fee 45 I n i t i a l B e h a v i o r a l O r g a n i z a t i o n 47 A3. B a s e l i n e 49 B a s e l i n e Data C o l l e c t i o n by the P a r e n t s . . 49 v i Page B. Treatment 53 B l . Parent T r a i n i n g Sessions 53 The T r i a d i c Model 55 S o c i a l P r a i s e Contingency T r a i n i n g 57 Time-Out 62 P o i n t or Token-Incentive C o n t r a c t i n g 62 Fading out the T h e r a p i s t ' s Involvement 6 9 B2. Assessment of Change 69 C. E v a l u a t i o n 73 CI. C o n s u l t a t i v e Follow-up 7 3 Chapter IV, Summary and Conclusi o n s 75 Overview 75 Proposed A l t e r n a t i v e Model 75 Some G u i d e l i n e s Regarding the A p p l i c a t i o n of the Model 76 1. ) Age of the C h i l d 77 2. ) The Importance of the Parent Mediator 79 3. ) Some C h a r a c t e r i s t i c s o f the T h e r a p i s t 79 4. ) The Model and What Types of Problems?...'.. 80 5. ) Assessment Before I n t e r v e n t i o n 82 How T h i s Model i s Unique From Other Models o f Family I n t e r v e n t i o n 82 I m p l i c a t i o n s f o r F u r t h e r Research 83 v i i L I S T OF F I G U R E S P a g e F i g u r e 1. - The T r i a d i c M o d e l 55 v i i i LIST OF NOTES Page Note 1 97 ix Acknowledgements The s u c c e s s f u l completion o f a t h e s i s i s not p o s s i b l e w i t h -out the help , c o o p e r a t i o n , and support o f many people. I wish to thank some of those people now who made t h i s study p o s s i b l e . I wish to thank my t h e s i s a d v i s o r , Dr. B i l l Borgen, f o r h i s support and encouragement i n t a c k l i n g a t h e s i s o f t h i s par-t i c u l a r nature. New ground was broken w i t h the s t y l e o f t h i s t h e s i s and Dr. Borgen was c r u c i a l i n s u p p o r t i n g and arguing f o r t h i s departure w i t h t r a d i t i o n . In j u s t over twelve months Dr. Borgen p r o v i d e d a f i n e b l e n d o f what I b e l i e v e t o be impor-t a n t q u a l i t i e s i n a t h e s i s s u p e r v i s o r . Not only d i d he have the i n t e l l i g e n c e and wisdom to deal with the many t h e o r e t i c a l and content i s s u e s o f the t h e s i s but he a l s o p r o v i d e d the warmth and companionship necessary f o r such a long journey. Thank-you, B i l l . For h i s years o f experience and knowledge i n the f i e l d o f f a m i l y therapy I wish to thank Dr. John F r i e s e n . In l o o k i n g i n -to such a v a s t and r e l a t i v e l y unexplored f i e l d as f a m i l y t h e r -apy i t was always a comfort t o know t h a t the reso u r c e s of such a man as Dr. F r i e s e n were r e a d i l y a v a i l a b l e . Dr. F r i e s e n 1 s c o n t r i b u t i o n s throughout the i n v e s t i g a t i o n were e s s e n t i a l to the completion o f t h i s study. I a l s o wish to thank Dr. Harold R a t z l a f f f o r h i s help i n t h i s study. Dr. R a t z l a f f p r o v i d e d the study w i t h a mixture o f e x p e r t i s e and i m p a r t i a l judgement t h a t I f e l t was necessary to an i n v e s t i g a t i o n o f t h i s nature. Furthermore, h i s e d i t i n g was X e s p e c i a l l y h e l p f u l i n c o r r e c t i n g f i r s t d r a f t s and p o l i s h i n g the f i n i s h e d product. Dr. R a t z l a f f e x e r c i s e d n o t h i n g s h o r t of sound judgement and guidance from the very b e g i n n i n g o f the s tudy. Furthermore, a s p e c i a l thanks i s extended to Dr. Myrne Nevison, Chairperson o f The Department of C o u n s e l l i n g P s y c h o l -ogy, f o r t r u s t i n g a hunch she had one day over two years ago when a young man came i n t o her o f f i c e a s k i n g f o r a chance t o make some dreams come t r u e . F i n a l l y , I wish to thank my t y p i s t , H i l d a Boudreau, who d i d such a f a n t a s t i c job i n t y p i n g and p r o o f r e a d i n g my t h e s i s . x i To my f a m i l y with l o v e . Chapter 1 I n t r o d u c t i o n to Study I n t r o d u c t i o n E f f e c t i v e approaches i n the treatment of c h i l d r e n with be-h a v i o r problems have i n t e r e s t e d p r o f e s s i o n a l c l i n i c i a n s f o r decades. The methods o f treatment tend to be as v a r i e d as the c l i n i c i a n s employing them. I n t e r v e n t i o n s t r a t e g i e s range from the Freudian p s y c h o a n a l y t i c approach to the R e a l i t y Therapy o f W i l l i a m G l a s s e r (1965), and from the n o n - d i r e c t i v e , c l i e n t -c e n t ered approach o f C a r l Rogers (1951) to the b e h a v i o r a l therapy o r s o c i a l l e a r n i n g approach f i r s t researched by B.F. Skinner (195 3) and most r e c e n t l y made popular by P a t t e r s o n (1975) and Tharp and Wetzel (1969). The environments chosen f o r the treatment of the problem c h i l d are almost as d i v e r s e as the t h e o r i e s o f treatments them-s e l v e s . L o c a t i o n s have ranged from the more t r a d i t i o n a l s e t t i n g of the t h e r a p i s t ' s o f f i c e , t o a classroom o r sch o o l s e t t i n g , to the home of the c h i l d . T h i s l a t t e r s e t t i n g f o r treatment has o n l y r e c e n t l y been p o p u l a r i z e d ( P a t t e r s o n , 19 75; Tharp and Wetzel, 1969; Fullmer and Bernard, 1968; Werry and Wollersheim, 1977; Fleischman and Conger, 1977). In f a c t , w i t h i n the l a s t f i v e to ten years an i n c r e a s i n g amount o f r e s e a r c h has ce n t e r e d on the i s s u e o f treatment l o c a l e . That i s to say, r e s e a r c h e r s have turned to i n v e s t i g a t e c o n d i t i o n s which a f f o r d the t h e r a p i s t h i s o r her b e s t chance of s u c c e s s f u l l y i n t e r v e n i n g i n the behavior o f the problem c h i l d . 2 More s p e c i f i c a l l y , comparisons have been made between the e f f e c t i v e n e s s o f the t h e r a p i s t ' s o f f i c e compared with the en-vironment where the problem o r i g i n a t e d . A c c o r d i n g t o much o f the r e s e a r c h t h a t i s c u r r e n t l y b e i n g p u b l i s h e d , the b e s t p o s s i b l e p l a c e f o r p o s i t i v e i n t e r v e n t i o n with a c h i l d i s the s o c i a l environment i n which the c h i l d spends the m a j o r i t y o f h i s time and i n the presence o f those who are most i n f l u e n t i a l upon him (Faust, 1 9 6 8 ; Tharp and Wetzel, 1 9 6 9 ) . ...given the adequate t r a i n i n g , s u p e r v i s i o n , and r e i n f o r c i n g feedback, parents can e f f e c t i v e l y •. " e l i m i n a t e the i n j u r i o u s conduct o f t h e i r c h i l d r e n (Bandura, 1 9 7 3 , p. 2 4 7 ) . The s o c i a l environment being r e f e r r e d to i s the home. A l -though the s c h o o l deeply a f f e c t s the l i f e o f the c h i l d and i s a powerful source of i n f l u e n c e i n the development of the c h i l d , F u llmer and Bernard ( 1 9 6 8 ) f e e l t h a t the f a m i l y i s s t i l l the primary i n f l u e n t i a l environment f o r the c h i l d . Clausen ( 1 9 6 6 ) says there i s no doubt t h a t i n a l l s o c i e t i e s a c h i l d ' s mother, f a t h e r and s i b l i n g s - the n u c l e a r f a m i l y - c o n s t i t u t e s the very core of h i s o r her e a r l y p e r s o n a l i t y development. Wagner ( 1 9 7 3 ) s t a t e s : I f we are to use our manpower i n the mental h e a l t h f i e l d w i t h maximum e f f e c t i v e n e s s , i t i s necessary f o r us t o put the therapy where the problem i s -i n the home (p. 2 9 5 ) . That a c h i l d ' s f a m i l y environment e x e r t s a primary amount of i n f l u e n c e on h i s behavior, both a t home, i n the scho o l and i n the community, r e p r e s e n t s a fundamental assump-t i o n upon which t h i s t h e s i s i s based. 3 Statement o f the Problem The problem to be i n v e s t i g a t e d r e q u i r e d the l o g i c a l assem-b l y o f many d i f f e r e n t areas of a l r e a d y proven r e s e a r c h and t e s t e d i n t e r v e n t i o n s t r a t e g i e s i n t o a new form or model. Heavy emphasis was g i v e n to; a) the e d u c a t i o n a l approach to t r a i n i n g parents i n b e t t e r c h i l d management techniques ( P a t t e r s o n , 19 75; Fleischman and Conger, 1977), b) the use o f the c h i l d ' s n a t u r a l environment as the arena f o r the i n t e r v e n t i o n (Tharp and Wetzel, 1969), and c) the a p p r o p r i a t e use o f the Rogerian (1951) or C a r k h u f f i a n (1967) communication s k i l l s combined wi t h s o c i a l l e a r n i n g theory i n e f f e c t i n g b ehavior and p e r c e p t i o n change. The model developed was a p p l i e d t c the blue c o l l a r f a m i l y . I t i s o f t e n experienced t h a t the c h i l d r e n of the blue c o l l a r f a m i l y e x h i b i t more behavior problems than o t h e r c l a s s e s of the p o p u l a t i o n and t h e r e f o r e seem a p p r o p r i a t e f o r t h i s study (Lewis, 1968). F i n a l l y , throughout the study I draw from my own case study experiences by o f f e r i n g examples from these f a m i l i e s to h i g h l i g h t s p e c i f i c techniques of the p a s t , p r e s e n t and the f u t u r e . O b j e c t i v e s The o v e r a l l o b j e c t i v e of t h i s study i s to c o n s t r u c t , through a review of the l i t e r a t u r e and from c l i n i c a l e x perience, a new model of treatment i n t e r v e n t i o n with the blue c o l l a r f a m i l y . 4 Sub-Goals a) To show by a review of the l i t e r a t u r e c o n t a i n i n g e x i s t i n g models of i n t e r v e n t i o n t h a t t r a i n i n g parents as i n t e r -v e n t i o n i s t s with t h e i r own c h i l d r e n i s an e f f e c t i v e technique. b) To d e f i n e by a review of the l i t e r a t u r e the unique c h a r a c t e r i s t i c s o f the blue c o l l a r f a m i l y . c) To develop by a review o f the l i t e r a t u r e and to i l l u s -t r a t e u s i n g excerpts from c l i n i c a l cases a model o f i n t e r v e n -t i o n with blue c o l l a r f a m i l i e s . d) To i l l u s t r a t e the d i f f e r e n c e between more t r a d i t i o n a l f a m i l y therapy and the model o f f a m i l y i n t e r v e n t i o n proposed by t h i s study. C o n t r i b u t i o n s o f the Study T h i s study should c o n t r i b u t e to the g e n e r a t i o n of a t h e o r e -t i c a l s t r u c t u r e t h a t w i l l enhance the p r o f e s s i o n a l c l i n i c i a n ' s p r a c t i c e . More s p e c i f i c a l l y , there are f o u r areas where i t i s f e l t t h i s study c o n t r i b u t e s . F i r s t o f a l l , i t should be apparent t h a t the proposed approach w i t h a problem c h i l d i s an economical treatment method. That i s , the time commitment o f the t h e r a p i s t i s s m a l l i n com-p a r i s o n to the r e s u l t s achieved and t h e r e f o r e the program i s in e x p e n s i v e . The treatment i s ongoing, 24 hours a day, i n the home of the c h i l d and c a r r i e d out by the parents of the c h i l d . 5 Secondly, there i s the e d u c a t i o n a l aspect to a b e h a v i o r -a l approach t h a t makes the o v e r a l l treatment p r e v e n t a t i v e . Parents are t r a i n e d i n more p r o f i c i e n t child-management s k i l l s t h a t d e a l w i t h not o n l y t h e i r p r e s e n t problem, but a l s o any f u t u r e problems. I t can be s a i d t h a t the treatment t h i s study i n v e s t i g a t e s has u n i v e r s a l a p p l i c a b i l i t y . T h i r d l y , a d e t a i l e d treatment or i n t e r v e n t i o n s t r a t e g y f o r the blue c o l l a r f a m i l y i s o u t l i n e d and an argument f o r i t s combination w i t h a behavior m o d i f i c a t i o n approach i s presented. F i n a l l y , what makes t h i s study unique from Tharp and Wetzel (1969), P a t t e r s o n (1975) and Fleischman and Conger (1978) i s i t s emphasis on the s p e c i a l i z e d communication s k i l l s the t h e r a p i s t b r i n g s to. a c o n s u l t a t i v e - s o c i a l l e a r n i n g approach. These s k i l l s are s i n g l e d out i n t h i s study and g i v e n a new emphasis w i t h i n the context o f a b e h a v i o r a l approach. D e f i n i t i o n of Terms The broad nature o f t h i s study d i c t a t e s the d e f i n i t i o n of s e v e r a l terms. The d e f i n i t i o n o f these terms should f a c i l i t a t e a b e t t e r understanding of the nature of the study. S o c i a l l e a r n i n g approach. The s o c i a l l e a r n i n g approach as de-f i n e d i n t h i s study i n d i c a t e s a l e a r n i n g theory approach t h a t has operant c o n d i t i o n i n g (Skinner, 1953) as i t s core. The b a s i c assumption u n d e r l y i n g the approach i s t h a t the organism performs i n a c e r t a i n manner a c c o r d i n g to the consequences o r 6 r e i n f o r c e m e n t which f o l l o w e d the same a c t on p r e v i o u s o c c a s i o n s . T h i s means t h a t there are a range of environmental events which are l i k e l y to produce a l e a r n e d response (Werry and Wollersheim, 1967). For young c h i l d r e n , t h e i r f a m i l y i s the primary d i s p e n -s e r of r e i n f o r c i n g and a v e r s i v e consequences. Synonomous terms f o r s o c i a l l e a r n i n g approach w i l l i n c l u d e behavior therapy (Ross, 1974; Wolpe, 1973), behavior m o d i f i c a t i o n (Skinner, 1953; G a m b r i l l , 1977) and reinforcement theory (Tharp and Wetzel, 1969). Behavior problem c h i l d . 'The behavior problem c h i l d i s d e f i n e d as the c h i l d i n the f a m i l y who e x h i b i t s such s o c i a l l y aggres-s i v e behavior t h a t he o r she, a) i s of such a concern to the f a m i l y t h a t p r o f e s s i o n a l h e l p i s sought, and/or b) cannot f u n c t i o n i n the p u b l i c s c h o o l system because of h i s / h e r s o c i a l l y a g g r e s s i v e behavior. For a l i s t o f s p e c i f i c b e h a v i o r s r e f e r t o Appendix E i n P a t t e r s o n . (1975) The emphasis l i e s upon o v e r t problem behaviors the c h i l d e x h i b i t s t h a t when performed r e p e a t e d l y become s o c i a l l y unacceptable. In t h i s study the term used most o f t e n to d e s c r i b e a c h i l d e x h i b i t i n g the l a t t e r b e haviors w i l l be the t a r g e t c h i l d o r problem c h i l d . Problem c h i l d ' s f a m i l y . The f a m i l y of the t a r g e t e d c h i l d w i l l mean to i n c l u d e a l l those who are n a t u r a l l y r e l a t e d to him and those who are r e l a t e d to him by law ( i e . d i v o r c e and re-mar-r i a g e , s t e p - s i s t e r s / b r o t h e r s ) . Therefore the f a m i l y of the problem c h i l d w i l l i n c l u d e the p a r e n t ( s ) , s i b l i n g s , grand-parents, aunts and u n c l e s . Emphasis w i l l l i e w i t h the members 7 of the f a m i l y w i t h whom the t a r g e t c h i l d l i v e s . Blue c o l l a r f a m i l y . The blue c o l l a r f a m i l y i s d e f i n e d f a m i l y whose income i s c l a s s i f i e d as lower than average and where the parents are e i t h e r s e m i - s k i l l e d or u n s k i l l e d workers. D i s t i n c t c h a r a c t e r i s t i c s of the working c l a s s i n d i v i d u a l i n -clude, among o t h e r s , a c t i o n - o r i e n t a t i o n r a t h e r than v e r b a l ; o r i e n t a t i o n toward problem and symptom removal r a t h e r than p e r s o n a l i t y change; e x t r o s p e c t i o n r a t h e r than i n t r o s p e c t i o n ; below average educ a t i o n , and i n a d o c t o r - p a t i e n t r e l a t i o n s h i p the blue c o l l a r parents are expectant o f more immediate, d i r e c t r e s u l t s (Gould, 1967). F u r t h e r d e s c r i p t i v e t r a i t s d f the blue c o l l a r f a m i l y are given i n Chapter I I . Communication s k i l l s . The d e f i n i t i o n of 'appropriate and e f f e c -t i v e communication s k i l l s i n v o l v e s what Rogers (1957) c a l l e d empathy, u n c o n d i t i o n a l p o s i t i v e regard, and congruence. Cark-h u f f and Truax (196 7) o p e r a t i o n a l i z e d these three t o o l s of the t h e r a p i s t as accurate empathy, nonpossessive warmth, and genuineness. Other synonomous terms i n c l u d e empathic communi-c a t i o n , r e s p e c t and a u t h e n t i c i t y (Hammond, Hepworth, and Smith, 1977) . L i m i t a t i o n s of the Study 1. The p o p u l a t i o n t h a t i s emphasized i n t h i s study i s the blue c o l l a r f a m i l y and t h e r e f o r e g e n e r a l i z a t i o n to o t h e r p o p u l a t i o n s with markedly d i f f e r e n t c h a r a c t e r i s t i c s would r e q u i r e f u r t h e r 8 i n v e s t i g a t i o n . 2 . No c a r e f u l l y c o n t r o l l e d s t a t i s t i c a l study was undertaken comparing the proposed model with o t h e r f a m i l y i n t e r v e n t i o n models. Although examples from a c t u a l case s t u d i e s are de-s c r i b e d i n the study, the emphasis l i e s i n the a n a l y s i s o f the i d e a l circumstances under which t h i s type o f i n t e r v e n t i o n can occur. Overview of the Study The study j u s t o u t l i n e d w i l l p r o g r e s s i n the f o l l o w i n g , manner. Chapter I I w i l l c o n s t i t u t e a review o f the l i t e r a t u r e r e g a r d i n g the behavior m o d i f i c a t i o n approach, the use of parents as change agents f o r t h e i r c h i l d r e n , and the c h a r a c t e r i s t i c s of the blu e c o l l a r f a m i l y . F o l l o w i n g Chapter II w i l l be a step-by-step look a t the proposed model. The f i n a l chapter w i l l p resent some important g u i d e l i n e s f o r the a p p l i c a t i o n o f the model. Furthermore, I w i l l address the d i f f e r e n c e between the p r e s e n t model and o t h e r models of f a m i l y i n t e r v e n t i o n and w i l l conclude w i t h some i m p l i c a t i o n s f o r f u r t h e r i n v e s t i g a -t i o n s . 9 Chapter I I Review of the L i t e r a t u r e  Overview The purpose o f t h i s chapter i s to present a t h e o r e t i c a l foundation f o r the development of a model f o r the treatment of blue c o l l a r f a m i l i e s . Concepts and r e s e a r c h a r t i c l e s w i l l be reviewed which address themselves to the t h e o r e t i c a l i s s u e s u n d e r l y i n g t h i s study. The major p o s i t i o n p resented i n t h i s study i s t h a t the p r i n c i p l e s and techniques of behavior modi-f i c a t i o n have c o n s i d e r a b l e v a l i d i t y i n the t r a i n i n g o f b l u e c o l l a r parents to c a r r y out t h e i r r e s p o n s i b i l i t i e s w i t h r e -spect to t h e i r c h i l d r e n . In d e v e l o p i n g the above p r o p o s i t i o n , i t i s the i n t e n t o f t h i s chapter to review the l i t e r a t u r e i n three d i s t i n c t areas: a) the s o c i a l l e a r n i n g approach, b) the use o f parents as change agents f o r t h e i r c h i l d r e n , and c) the c h a r a c t e r i s t i c s of the b l u e c o l l a r f a m i l y . In the l a t t e r s e c t i o n s the three areas w i l l be woven together i n t o an i n t e g r a t e d s t r u c t u r e . To review a l l of the l i t e r a t u r e i n these three widely r e s e a r c h -ed areas of i n v e s t i g a t i o n would be a p r a c t i c a l i m p o s s i b i l i t y s i n c e volumes have been w r i t t e n i n each area. Consequently i t i s my i n t e n t to review the l i t e r a t u r e which has immediate rele v a n c e to the area of i n q u i r y . The c r i t e r i a used i n the s e l e c t i n g o f the l i t e r a t u r e are: 10 1) O n l y v e r y c o n t e m p o r a r y a r t i c l e s a r e r e v i e w e d f o r t h i s c h a p -t e r . 2) The r e v i e w o f t h e l i t e r a t u r e was s e l e c t e d f r o m r e s e a r c h c o n -d u c t e d w i t h b l u e c o l l a r C a u c a s i a n p a r e n t s f r o m C a n a d a a n d t h e U n i t e d S t a t e s . 3) A r t i c l e s r e v i e w e d i n t h e a r e a o f p a r e n t i n g w e r e b a s e d o n a b e h a v i o r m o d i f i c a t i o n a p p r o a c h u s i n g b l u e c o l l a r p a r e n t s a n d t h e i r c h i l d r e n . A s a means o f d e v e l o p i n g t h e t h e o r e t i c a l f o u n d a t i o n f o r t h i s s t u d y , t h e s o c i a l l e a r n i n g a p p r o a c h was i n t r o d u c e d i n a g e n e r a l m a n n e r a n d was c o m p a r e d w i t h o t h e r p s y c h o t h e r a -p e u t i c m o d e l s , t h e a d v a n t a g e s a n d d i s a d v a n t a g e s o f t h e s o c i a l l e a r n i n g a p p r o a c h w e r e e n n u n c i a t e d , . a n d t h e c o n c e p t s a n d t e r m s o f s o c i a l l e a r n i n g t h e o r y d e f i n e d . S e c o n d l y , t h e l i t e r a -t u r e was r e v i e w e d w h i c h d e m o n s t r a t e d t h e e f f i c a c y o f t h e u s e o f p a r e n t s a s p s y c h o t h e r a p e u t i c a g e n t s i n t h e t r a i n i n g o f t h e i r c h i l d r e n , a n d t h i r d l y , t h e r e s e a r c h r e l a t i n g t o t h e c h a r a c t e r i s t i c s o f t h e b l u e c o l l a r f a m i l y w i l l b e r e v i e w e d . F o u r t h l y , f r o m my p e r s o n a l e x p e r i e n c e a s w e l l a s r e s e a r c h e r s ' e x p e r i e n c e w i t h t h e s t r u c t u r e a n d t h e c u l t u r e o f t h e b l u e c o l l a r f a m i l y , a t r e a t m e n t s t r a t e g y e v o l v e d ; - F i n a l l y , t h e m e t h o d o f t r e a t m e n t t h a t h a s c r y s t a l l i z e d f r o m t h e b l u e c o l l a r s t r u c t u r e a n d c u l t u r e was c o m p a r e d w i t h t h e a d v a n t a g e s o f u s i n g a b e h a v i o r m o d i f i c a t i o n a p p r o a c h o v e r o t h e r a p p r o a c h e s . 11 Introduction to S o c i a l Learning Theory Social learning theory grew out of the o v e r a l l framework of the c a r e f u l l y controlled laboratory experiments of c l a s s i c a l and operant conditioning (Pavlov, 1927; Skinner, 1938). With i t s emphasis on overt behavior, operant conditioning experi-ments f i r s t attempted to control the behavior of animals by manipulating the contingencies of t h e i r environment. Relating behavioral p r i n c i p l e s to humans, behavior therapists, who talk about maladaptive behaviors rather than psychopathology, be-l i e v e that abnormal as well as normal behaviors are acquired according to the same behavioral p r i n c i p l e s . In a s o c i a l learning approach the appropriate arena for changing a person's behavior i s the environment i n which that person l i v e s . The family controls much of the environment which can a f f e c t the response of a behavior problem c h i l d (Tharp and Wetzel, 1969). A s o c i a l learning t h e o r i s t who wanted to help a c h i l d resolve some s p e c i f i c problem behaviors would therefore want to work in the home with the people who control the reinforcers for the targeted c h i l d . Bandura (1973) sees the guidelines for t h i s intervention in the following manner: By treating the actual problems i n the contexts with-in which they arise, with i n f l u e n t i a l members in those settings, s o c i a l learning procedures are i d e a l l y suited for achieving enduring changes in psychological func-tioning. The further one departs from these optimal conditions the weaker the results are l i k e l y to be (p. 247) . Ross ( 1 9 7 4 ) notes t h a t the focus o f behavior therapy i s on the c u r r e n t p r e s e n t i n g behavior and i t s accompanying c u r r e n t circumstances. The c h i l d ' s p a s t h i s t o r y i s co n s i d e r e d o n l y to the extent t h a t i t w i l l a i d i n r e s o l v i n g the presen t b e h a v i o r problems. Other c u r r e n t p s y c h o l o g i c a l t h e o r i e s regard behavior as having i t s r o o t s i n a person's past. For example, a psycho-a n a l y s t uses v a r i o u s a n a l y t i c techniques to help h i s p a t i e n t become aware o f c e r t a i n p a s t experiences t h a t are b l o c k i n g him or her from a h e a l t h y l i f e s t y l e . At o t h e r times p a t i e n t s are s a i d to be stagnated at an e a r l i e r psychosexual stage o f l i f e . Other p s y c h o t h e r a p i e s p l a c e an emphasis on the h i s t o r y of t h e i r c l i e n t and b e l i e v e t h a t i t holds the key to t h e i r i l l n e s s . T h e r e f o r e , i f we assume t h a t the causes o f behavior r e s i d e i n the pre s e n t and not i n the pa s t then most other t h e o r i e s o f treatment are not u s e f u l . Reinforcement Theory Predominant i n the t h e o r e t i c a l o r i e n t a t i o n o f behavior m o d i f i c a t i o n i s reinforcement theory. Reinforcement theory embodies the p r i n c i p l e s d e a l i n g w i t h behavior and i t s conse-quent events. B a s i c to reinforcement theory i s Skinner's ( 1 9 5 3 ) a s s e r t i o n t h a t i f a behavior i s rewarded the p r o b a b i l -i t y t h a t same behavior w i l l be repeated i n the f u t u r e i s i n -creased. T h i s i s the core p r i n c i p l e o f operant c o n d i t i o n i n g . Through a p p l i c a t i o n o f reinforcement theory, behavior p a t t e r n s can be e s t a b l i s h e d , maintained or e x t i n g u i s h e d . Though reinforcement theory has been s c i e n t i f i c a l l y and p r o f e s s i o n a l l y generated i t i s h i g h l y r e l a t e d to common human e x p e r i e n c e s a n d c a n b e u s e f u l i n p r o v i d i n g e f f e c t i v e c o n s u l t a -t i o n w i t h p e r s o n s f r o m m a n y n o n - p r o f e s s i o n a l w a l k s o f l i f e . ( T h a r p a n d W e t z e l , 1969). K r a s n e r (1971) e m p h a s i z e s t h i s p o i n t w h e n h e n o t e s t h a t t h e k e y d i f f e r e n c e b e t w e e n d y n a m i c - b a s e d t h e o r i e s o f c h a n g e a n d o p e r a n t - b a s e d a p p r o a c h e s i s o n e o f t h e c h a n g i n g r o l e o f t h e h e a l e r . W h e t h e r t h e y a r e a t e a c h e r , a n u r s e , a p a r e n t o r a s i b l i n g , t h e h e a l i n g r o l e h a s b e e n n a t u r -a l l y a d o p t e d b y a m e m b e r o f t h e i m m e d i a t e e n v i r o n m e n t i n w h i c h t h e m a l a d j u s t e d i n d i v i d u a l l i v e s . C o m p a r i s o n o f S o c i a l L e a r n i n g T h e o r y w i t h O t h e r P s y c h o t h e r a p i e s T h e r e a r e m a n y o t h e r p s y c h o t h e r a p i e s t h a t o f f e r d i s t i n c t i v e i n t e r p r e t a t i o n s o f h u m a n b e h a v i o r ( C o r s i n i , 19 73). T h r e e o f t h e m o r e w i d e l y u s e d p s y c h o t h e r a p i e s a r e p s y c h o a n a l y s i s ( F r e u d , 1936), A d l e r i a n p s y c h o t h e r a p y ( A n s b a c h e r a n d A n s b a c h e r , 1953) a n d c l i e n t - c e n t e r e d p s y c h o t h e r a p y ( R o g e r s , 1957). P s y c h o a n a l y s i s . P s y c h o a n a l y t i c t h e r a p i s t s v i e w m a n ' s b e -h a v i o r a s b e i n g d r i v e n b y u n c o n s c i o u s , i n s t i n c t u a l l y d e r i v e d f o r c e s . I t i s t h e t h e r a p i s t ' s j o b t o h e l p b r i n g t h e s e f o r c e s t o t h e p a t i e n t ' s c o n s c i o u s n e s s b y h a v i n g t h e p a t i e n t r e - l i v e c e r t a i n s t a g e s o f a n a l y t i c d e v e l o p m e n t a n d b y a p r o c e s s c a l l e d t r a n s f e r e n c e . T r a n s f e r e n c e r e f e r s t o t h e p r o c e s s w h e r e b y t h e p a t i e n t r e - l i v e s s o m e ' u n f i n i s h e d b u s i n e s s ' o f h i s / h e r p a s t i n t h e p r e s e n t b y r e e x p e r i e n c i n g c e r t a i n f e e l i n g s o f r e j e c t i o n o r h o s t i l i t y . T h e p a t i e n t t r a n s f e r s t h e s e f e e l i n g s o n t o t h e a n a l y s t ( C o r e y , 1977). M a l a d a p t i v e b e h a v i o r i n t h e p a t i e n t i s p a r t l y a r e s u l t o f p o o r p s y c h o s e x u a l d e v e l o p m e n t a n d a n u n -r e s o l v e d O e d i p u s c o m p l e x . T h e O e d i p u s c o m p l e x i s a p e r i o d 14 where the c h i l d wishes to r e p l a c e a parent of the same sex and to have sex or b o d i l y c o n t a c t w i t h the parent o f the o p p o s i t e sex ( C o r s i n i , 1973, p. 13-14). C o n s i d e r i n g the focus o f the p r e s e n t i n v e s t i g a t i o n psycho-a n a l y s i s would seem l i k e a d i f f i c u l t technique to employ. R e i -s i n g e r , Ora and F r a n g i a (1976), i n d i s c u s s i n g p s y c h o a n a l y t i c procedures and the use of p a r e n t s , notes: t h a t an a c t i v e r o l e f o r the parent has not been charac-t e r i s t i c o f t h i s treatment model. Instead, when the parent has been i n v o l v e d i n therapy, i t has f r e q u e n t l y been f o r treatment o f t h e i r own problems which were thought to be a f f e c t i n g t h e i r c h i l d (p. 113). To teach the parents anything about p s y c h o a n a l y t i c procedures would probably be a long and strenuous task and t h e r e f o r e t h i s theory u s u a l l y r e q u i r e s the t h e r a p i s t to work d i r e c t l y with the p a t i e n t . F i n a l l y , even on a one-to-one b a s i s , the m a j o r i t y of times p s y c h o a n a l i s t s t r e a t a d u l t p a t i e n t s r a t h e r than c h i l d r e n . A d l e r i a n psychology. A d l e r i a n psychology was formulated by A l f r e d A d l e r (1927). L i k e p s y c h o a n a l y s i s , i t i s a psycho-therapy whose o p e r a t i n g p r i n c i p l e s seem so complex t h a t they can o n l y be understood and e x p l a i n e d by someone s p e c i a l l y t r a i n e d i n i t s theory. An A d l e r i a n views m o t i v a t i o n i n e a r l y c h i l d h o o d i n terms o f the c h i l d ' s p e r c e p t i o n s o f h i s or her f a m i l y c o n s t e l l a t i o n and h i s s t r u g g l e to f i n d a p l a c e of im-portance w i t h i n i t . A d l e r i a n s are very much l i k e b e h a v i o r i s t s working with a f a m i l y i n t h a t they b e l i e v e t h a t man cannot be understood i n i s o l a t i o n ; t h a t man i s a s o c i a l being. C l i e n t - c e n t e r e d therapy. Rogerians see man as being i n a constant s t a t e of moving towards . ' s e l f - a c t u a l i z a t i o n ' . The t h e r a p i s t , t r a i n e d i n Rogerian ph i l o s o p h y , t r i e s to c r e a t e f o r the c h i l d an atmosphere or c e r t a i n t h e r a p e u t i c c o n d i t i o n s a p p r o p r i a t e f o r t h i s growth to take p l a c e . L i k e A d l e r i a n therapy and p s y c h o a n a l y s i s , c l i e n t - c e n t e r e d therapy i s a t e c h -nique t h a t i s used mostly by p r o f e s s i o n a l s i n a one-to-one approach with t h e i r c l i e n t . The use of n o n - p r o f e s s i o n a l s t r a i n e d i n the approach i s common but r e q u i r e s i n t e n s i v e and expert t r a i n i n g . The t h e r a p e u t i c c o n d i t i o n s o f acc u r a t e em-p a t h i c understanding, u n c o n d i t i o n a l p o s i t i v e regard, and genuiness o r congruence would take many hours o f l e a r n i n g (Hammond, Hepworth, and Smith, 1977). A x l i n e (1964) notes how few s t u d i e s have d e t a i l e d a Rogerian approach which u t i l i z e d the parent as a change agent. Instead the l i t e r a t u r e has focused on onl y the p r o f e s s i o n a l and the c l i e n t . About the on l y Rogerian approach which does employ parents i n the t r e a t -ment of t h e i r c h i l d r e n i s f i l i a l therapy (Guerney, 1969). F i l i a l therapy t r a i n s parents to conduct s t a n d a r d i z e d p l a y s e s s i o n s w i t h t h e i r c h i l d r e n . Rogers b e l i e v e s t h a t 'the f o r c e s o f s e l f - a c t u a l i z a t i o n i n the i n f a n t and c h i l d bump up a g a i n s t c o n d i t i o n s which s i g n i f -i c a n t o t hers i n h i s l i f e impose upon him' (1953, p. 126). Be-h a v i o r therapy t r i e s to educate the s i g n i f i c a n t o t h e r s r e g a r d -ing t h e i r c o n t r o l o f these c o n d i t i o n s and what e f f e c t these c o n d i t i o n s have on t h e i r c h i l d . O v e r a l l , i t would appear t h a t b e h a v i o r i s t s and Rogerians have on l y concentrated on the p o s i t i v e aspects o f p a r e n t a l i n c l u s i o n i n treatment while the psychodynamic t h e r a p i s t s have feuded about i t s p i t f a l l s and wondered how parents c o u l d be p r o p e r l y i n c l u d e d a t a l l . I t would appear t h a t i n most cases, across most therapy models, the use or e x c l u s i o n o f the parents as agents of change f o r t h e i r c h i l d r e n depends on the p r o f e s -s i o n a l ' s a f f i l i a t i o n w i t h a p a r t i c u l a r treatment model or theory ( R e i s i n g e r , Ora, F r a n g i a , 1976). E v a l u a t i o n of the S o c i a l L e a r n i n g Approach Disadvantages. The disadvantages o f u s i n g a s o c i a l l e a r n -i n g approach are w e l l documented by many authors (Corey, 19 77; Carkhuff and Berenson, 1967; P a t t e r s o n , 1973; O ' D e l l , 1974). A c o l l e c t i o n of the more popular c r i t i c i s m s appears below. 1. Behavior therapy u s u a l l y i g n o r es the p a s t h i s t o r y of a c l i e n t when f o r m u l a t i n g p o s s i b l e avenues of a c t i o n c o n cerning a p r e s e n t problem. 2. Behavior therapy o f t e n does not p r o v i d e the c l i e n t w i t h the i n s i g h t i n t o why he/she behaves i n a p a r t i c u l a r manner. 3. Behavior therapy mostly ignores the r e l a t i o n a l f a c t o r s i n c r e a t i n g a conducive t h e r a p e u t i c atmosphere f o r the c l i e n t and the t h e r a p i s t ; there i s a mechanical and nonhumanistic l e v e l of i n t e r c h a n g e . 4. Behavior therapy u s u a l l y focuses only on behaviors and does not focus upon the c l i e n t ' s f e e l i n g s . 5. Behavior therapy deals o n l y with o v e r t l y s p e c i f i c problems and does not appear to be able to address i t s e l f t o broader problems o f p e r s o n a l and s o c i a l adjustments more o f t e n t a c k l e d i n t r a d i t i o n a l psychotherapy. 17 6. For c l i e n t s who appear t o be f u n c t i o n i n g at r e l a t i v e l y h i g h coping l e v e l s , behavior therapy does not, i n most cases, appear a p p l i c a b l e . Corey (1977) s t a t e s , ' I t does appear t h a t behavior therapy does not have much to o f f e r f o r the c l i e n t who does not have s p e c i f i c maladaptive problems' (p. 136). 7. Behavior therapy more o f t e n d e a l s with symptom removal r a t h e r than a d d r e s s i n g i t s e l f to the cause o f the d i s o r d e r . 8. With such a mechanical o r i e n t a t i o n some c r i t i c s wonder whether c l i e n t s can g e n e r a l i z e t h e i r problem s o l v i n g s k i l l s to other areas i n which they are e x p e r i e n c i n g problems. 9. I t i s argued t h a t a person equiped i n b e h a v i o r a l techniques can use these s k i l l s to manipulate, e i t h e r c o n s c i o u s l y or un-c o n s c i o u s l y , the behavior of others f o r t h e i r own b e n e f i t s . Advantages. The advantages of u s i n g a s o c i a l l e a r n i n g approach i n t r a i n i n g parents appear to outweigh the disadvan-tages of u s i n g such an approach. O'Dell (1974), i n an a r t i c l e on parent t r a i n i n g , summarized the many advantages of a s o c i a l l e a r n i n g approach. 1. The use of n o n p r o f e s s i o n a l s who can l e a r n the p r i n c i p l e s and techniques of behavior m o d i f i c a t i o n and c a r r y out i n t e r -v e n t i o n programs i s common to b e h a v i o r therapy. 2. The theory u n d e r l y i n g behavior m o d i f i c a t i o n i s l a b o r a t o r y d e r i v e d and t e s t e d . 3. The techniques of behavior m o d i f i c a t i o n can be taught to l a r g e groups. 4. The a c t u a l t r a i n i n g time i n behavior therapy i s s h o r t . 18 5 . The o v e r a l l impact o f a s o c i a l l e a r n i n g approach on o v e r t problem behaviors i s u s u a l l y g r e a t e r than one-to-one treatment models. 6. The s o c i a l l e a r n i n g model i s not based on the medical model which sees maladaptive behaviors as ' s i c k 1 . Rather, b e h a v i o r problems are l e a r n e d and t h e r e f o r e p r o d u c t i v e , f a c i l i t a t i v e b e h avior i s simply a matter o f proper l e a r n i n g and r e i n f o r c e -ment. 7 . Most c h i l d h o o d problems c o n s i s t of w e l l - d e f i n e d , e a s i l y o b s e rvable problem behaviors which l e n d themselves p e r f e c t l y to a b e h a v i o r m o d i f i c a t i o n approach. 8. As an i n t e r v e n t i o n s t r a t e g y b e h a v i o r m o d i f i c a t i o n i s i d e a l i n d e a l i n g w i t h problems i n the c h i l d ' s n a t u r a l environment. Bandura (19 73) says t h a t what most people need i s , 'not the i n s i g h t t h a t they are behaving inadequately but the means to l e a r n more s u c c e s s f u l ways o f behaving' (p. 2 5 3 ). T h i s would appear to be even more the case w i t h c h i l d r e n who need to l e a r n b e t t e r ways of behaving around others r a t h e r than the deep i n s i g h t i n t o why they behave the way they do. One o f the b e s t comparative s t u d i e s on b e h a v i o r a l and r e f l e c t i v e parent c o u n s e l l i n g techniques appears to be Tavormina's ( 1 9 7 5 ) . Tavormina concludes, t h a t b e h a v i o r a l parent c o u n s e l l i n g i s more e f f e c t i v e than the o t h e r approa-ches. I t would appear on the b a s i s o f the s t u d i e s c i t e d t h a t a s o c i a l l e a r n i n g approach i s v i a b l e i n working w i t h behavior problem c h i l d r e n , i n t h e i r home, u s i n g the parents as the primary t h e r a p i s t s . 19 D e f i n i t i o n of B e h a v i o r a l Terms D e f i n i t i o n of terms o f t e n used i n c o u n s e l l i n g employing s o c i a l l e a r n i n g techniques should prove h e l p f u l t o the under-standing o f the p r e s e n t i n v e s t i g a t i o n . Contingency management. Contingency management i s the .. rearrangement o f the environmental rewards and punishments which e i t h e r strengthen or weaken subsequent b e h a v i o r s (Tharp and Wetzel, 1969). Contingency manager. The contingency manager i s a person whose knowledge q u a l i f i e s him to s p e c i f y the c o r r e c t p a t t e r n s of r e o r g a n i z e d c o n t r o l v i a c o n s u l t i n g w i t h the p a r e n t s . He m o d i f i e s the b e h a v i o r of the parents so t h a t they w i l l c o r -e c t l y o r g a n i z e the environment of the t a r g e t e d c h i l d (Tharp and Wetzel, 1969). E x t i n c t i o n . The gradual r e d u c t i o n i n the frequency and subsequent removal o f a behavior f o l l o w i n g the withdrawal of m a i n t a i n i n g r e i n f o r c e r s i s known as e x t i n c t i o n . Fading. Fading i s the g r a d u a l l e s s e n i n g o f treatment c o n t a c t s from perhaps d a i l y c o n t a c t down to approximately once a week p r i o r to t e r m i n a t i o n . The t h e r a p i s t e v e n t u a l l y turns the whole program over to the parents and t h e i r t a r g e t e d c h i l d to run on t h e i r own w i t h perhaps the odd 'booster shot' by the t h e r a p i s t (See Fleischman and Conger, 1977). Mediator. The mediator i s u s u a l l y , but not always, the parents o f the t a r g e t e d c h i l d . He or she occupies an i n t e r -mediary p o s i t i o n between the t a r g e t c h i l d and the t h e r a p i s t . Tharp and Wetzel (1969) b e l i e v e t h a t when u s i n g a s o c i a l l e a r n i n g approach i n the n a t u r a l environment t h a t the o v e r a l l e f f e c t i v e n e s s o f the i n t e r v e n t i o n r e s t s w i t h the behavior of the mediators or the par e n t s . P o s i t i v e r e i n f o r c e r s . P o s i t i v e r e i n f o r c e r s are those t h i n g s or events t h a t when presented tend t o i n c r e a s e the l i k e l i h o o d t h a t a c e r t a i n b e h a v i o r w i l l occur again. Some example of p o s i t i v e r e i n f o r c e r s are money, s m i l e s , a t t e n t i o n by a s i g -n i f i c a n t o t h e r (parent) and food. Time-out. Time-out i s the immediate s e p a r a t i o n o f the t a r g e t e d c h i l d from a s i t u a t i o n t h a t i n some way r e i n f o r c e s h i s i n a p p r o p r i a t e behavior. The s e p a r a t i o n i s onl y f o r very s h o r t p e r i o d s o f time, u s u a l l y no more than ten minutes, i n t o an environment t h a t i s as n o n - s o c i a l l y r e i n f o r c i n g as p o s s i b l e Use of Parents as Ps y c h o t h e r a p e u t i c Agents The h y p e r p r o f e s s i o n a l i z a t i o n of the mental h e a l t h p r o f e s s i o n a l s m i l i t a t e s a g a i n s t the use of s o c i e t y ' s g r e a t e s t r e s o u r c e s : the c l i e n t ' s n a t u r a l r e l a t i o n -s h i p s , with t h e i r e x t r a o r d i n a r y p o t e n t i a l power f o r gene r a t i n g behavior change (Tharp and Wetzel, 1969, p. 2) . Guerney (1969) notes t h a t i n the area o f mental h e a l t h problems the use of n o n p r o f e s s i o n a l s has s t e a d i l y i n c r e a s e d over the p a s t decade. Of the r e s e a r c h i n t h i s area, the major i t y o f i t has i n v e s t i g a t e d p arent t r a i n i n g approaches ( O ' D e l l , 1974). The focus o f c u r r e n t r e s e a r c h e f f o r t s i n v o l v i n g parent tends to focus on programs u s i n g a s o c i a l l e a r n i n g approach (O'Dell, 1974). 21 There are three d i s t i n c t l i n e s o f reasoning t h a t would seem to suggest t h a t parents are of primary importance i n d e a l -r i n g w ith mental h e a l t h problems o f c h i l d r e n . F i r s t , by t r a i n -i n g parents i n more e f f e c t i v e c h i l d management techniques the mental h e a l t h p r o f e s s i o n a l i s d i r e c t l y a d d r e s s i n g the important i s s u e o f p r e v e n t i o n . Changes i n behavior of the s i g n i f i c a n t a d u l t s i n a c h i l d ' s l i f e are u s u a l l y more important than d i r e c t s e r v i c e s to t h a t c h i l d ( C h r i s t e n s e n , 1972). I t i s d u r i n g the formative p r e s c h o o l years t h a t the parents have primary i n -fl u e n c e over t h e i r c h i l d r e n and t h e r e f o r e i t i s the parents who are p o s i t i o n e d b e s t to p r o v i d e p r e v e n t a t i v e s e r v i c e s (Hawkins, 19 72). Some r e s e a r c h e r s see the p r e v e n t i o n of c h i l d -hood mental h e a l t h problems as having the h i g h e s t p r i o r i t y i n community mental h e a l t h ( G l i d e w e l l , 19 71). A second argument which addresses the i s s u e of parent i n -volvement i s t h a t the number o f c h i l d r e n i n need of some s o r t of mental h e a l t h s e r v i c e f a r outnumbers the number of pro-f e s s i o n a l s a v a i l a b l e ( L i n d s l e y , 1966). One r e s e a r c h e r b e l i e v e s t h a t the number o f c h i l d r e n w i t h behavior problems i s so l a r g e t h a t o n l y by i n s t i t u t i n g a compulsory p a r e n t t r a i n i n g program i n the schools can the problem be brought under some degree of c o n t r o l (Hawkins, 1972). F i n a l l y , and perhaps most i m p o r t a n t l y , there i s the i s s u e of whether behavior change can t r u l y be e f f e c t i v e i f the t r e a t -ment does not l e n d i t s e l f to the environment i n which the pro-blem manifests i t s e l f . Tharp and Wetzel (1969) note; No f i e l d o f treatment or r e h a b i l i t a t i o n , no o r g a n i z e d attempt to a l t e r human beha v i o r , i s without c o n t i n u a l 22 c o n f r o n t a t i o n by evidence t h a t the environment i n which the i n d i v i d u a l i s embedded i s p r i n c i p a l l y r e s p o n s i b l e f o r the o r g a n i z a t i o n o r d i s o r g a n i z a t i o n , the maintenance or change, the appearance or d i s -appearance o f any behavior (p. 7) . The therapy, then, must be e a s i l y adaptable f o r use i n the c h i l d ' s n a t u r a l environment and working i n t h i s environment i n e v i t a b l y leads to p a r e n t a l involvement. The parents c o n t r o l the m a j o r i t y of the environmental c o n t i n g e n c i e s f o r t h e i r c h i l d -ren. T h e r e f o r e , the parent's involvement as di s p e n s e r s o f r e -inforcement i s c r u c i a l to the success o r f a i l u r e o f t h i s approach. (Tharp and Wetzel, 1969.) T r a i n i n g Parents i n Operant Techniques - Background One of the f i r s t times t h a t parents were c i t e d as change agents f o r t h e i r c h i l d r e n was i n 1909 when Sigmund Freud used a c h i l d ' s f a t h e r as a p s y c h o a n a l y t i c agent i n the case o f ' L i t t l e Hans' (Freud, 1959). One of the f i r s t experiments demonstrating t h a t a person u n s k i l l e d i n behavior m o d i f i c a t i o n c o u l d be taught to c o n t r o l c e r t a i n b e h a v i o r s i n o t h e r s by man i p u l a t i n g reinforcement c o n t i n g e n c i e s was done by A y l l o n and M i c h a e l (1959). In behavior therapy the use o f parents i n the treatment o f t h e i r c h i l d r e n goes back as f a r as the e a r l y 1930's (Weber, 1936). O'Dell (1974) c r e d i t s Pumroy (19 65) w i t h one o f the f i r s t s t u d i e s at te a c h i n g parents the p r i n c i p l e s and techniques o f behavior m o d i f i c a t i o n . Behavior m o d i f i c a t i o n t r a i n i n g with parents i s a new f i e l d w i t h almost two t h i r d s o f the r e s e a r c h done s i n c e 1968 (Goodall, 1972). P a t t e r s o n (1971) sees a c u r r e n t t r e n d to develop more powerful procedures f o r t r a i n i n g p a rents than j u s t the i n t e r v i e w . Berkowitz (1972) echoes P a t t e r s o n ' s con-cern when he notes t h a t many d i f f e r e n t procedures f o r t r a i n i n g parents are being t r i e d . Among some t h a t are l i s t e d are group and i n d i v i d u a l approaches, d i r e c t coaching, m o d e l l i n g , parent group d i s c u s s i o n s , assigned readings and programmed m a t e r i a l s . I t would appear t h a t a good approach t o t r a i n i n g parents to be e f f e c t i v e w i t h t h e i r c h i l d r e n would i n c l u d e some combination of a l l of the above methods. Today, however, r e s e a r c h e r s p r e d i c t t h a t w i t h i n the next decade c o u n s e l l i n g w i l l s h i f t i t s focus away from i n d i v i d u a l and group approaches towards methods which w i l l a f f e c t the s o c i a l environment of i n d i v i d u a l s and thereby reach l a r g e r p o p u l a t i o n s o f people. Hutchinson and S t a d l e r (1975) i n t h e i r book S o c i a l Change C o u n s e l l i n g : A R a d i c a l Approach are advo-cates of an approach to c o u n s e l l i n g which acknowledges the sometimes d e t r i m e n t a l e f f e c t s o f accepted s o c i a l i z a t i o n and s o c i a l i n s t i t u t i o n s o f the western c u l t u r e . For example, where a t r a d i t i o n a l f a m i l y t h e r a p i s t might diagnose a c h i l d ' s problem as being the r e s u l t o f poor i n t e r r e l a t i o n s h i p s w i t h i n the f a m i l y , a t h e r a p i s t w i t h a s o c i a l change o r i e n t a t i o n would argue t h a t i t i s the o v e r a l l i n s t i t u t i o n of the f a m i l y which causes the problem and not n e c e s s a r i l y the i n t e r a c t i o n s o f the parents and s i b l i n g s . A c h i l d ' s e a r l y s o c i a l environment i s i n f l u e n c e d mostly by h i s parents (Hawkins, 1972). The t h e r a p i s t , u s i n g a s o c i a l l e a r n i n g approach, sees the use o f these parents as mediators and co-workers as b e i n g of primary importance. For the t h e r a -24 p i s t t o achieve maximum e f f i c i e n c y the parent o f the c h i l d w i l l have to be brought i n t o the m i l i e u of treatment (Lucky, 1967). Blue C o l l a r Family Many r e s e a r c h e r s have d e f i n e d groups o r p o p u l a t i o n s o f parents t h a t they would not c o l l a b o r a t e with but few, i f any, have d e f i n e d the parameters f o r p r e d i c t i n g high and low success parents f o r u s i n g a parent t r a i n i n g approach (Graziano, 1977). W i l t z (196 9) and P a t t e r s o n (19 65) excluded parents who appeared p s y c h o t i c . Others, such as B e r n a l (1973) , screened out f a m i l -i e s i n which there was sharp m a r i t a l d i s c o r d . S t r i c t e r paren-t a l types who would not be accepted f o r parent t r a i n i n g were parents who were d e s c r i b e d as c o n f l i c t u a l and had e x c e s s i v e r i g i d i t y (Tharp and Wetzel, 19 69) . There are r e s e a r c h e r s on both s i d e s of the i s s u e p e r t a i n -i n g to the a d v i s a b i l i t y o f involvement of parents from d i f f e r -ent socioeconomic l e v e l s as change agents f o r t h e i r c h i l d . H i r s c h and Walden (1969) and Mira (1970) b e l i e v e t h a t there i s no r e l a t i o n s h i p between a parent's socioeconomic l e v e l and h i s / h e r subsequent success i n a parent t r a i n i n g program. On the other hand, R e i s i n g e r e t a l (19 76) see a d e f i n i t e r e l a t i o n between the two. P a t t e r s o n e t a l (19 72) b e l i e v e s t h a t lower s o c i o -economic parents should not be t r a i n e d i n p a r e n t i n g techniques because they are d e f i c i e n t i n even the most b a s i c c h i l d manage-ment s k i l l s . A d d r e s s i n g the t o p i c o f l o w e r - c l a s s f a m i l i e s and t h e i r s u i t a b i l i t y o r n o n - s u i t a b i l i t y f o r parent t r a i n i n g programs, R e i s i n g e r e t a l (1976) s t a t e s ; Many b e h a v i o r a l s t u d i e s have co n c e n t r a t e d upon the m i d d l e - c l a s s f a m i l y , w h ile few s t u d i e s have e x p l o r e d the l o w e r - c l a s s f a m i l y response to i n t e r v e n t i o n t r a i n -i n g . The a v a i l a b l e evidence suggests t h a t the l a t t e r f a m i l i e s r e a c t l e s s e n t h u s i a s t i c a l l y and e f f i c i e n t l y to i n t e r v e n t i o n programming than do m i d d l e - c l a s s f a m i l -i e s (p. 107). However, what appears to be more important i s an i n v e s t i -g a t i o n of what s t y l e o f i n t e r v e n t i o n or type of treatment i s s p e c i a l l y s u i t a b l e f o r t h i s type o f c l i e n t . I have a l s o noted and concur with G o l d s t e i n (19 7 3) when he s t a t e s : Perhaps the most s i g n i f i c a n t f a i l u r e i n contemporary psychotherapy has been the marked absence of t r e a t -ment approaches of demonstrated or even apparent u s e f u l n e s s f o r lower-and w o r k i n g - c l a s s p a t i e n t s . The wide a r r a y of attempts to employ t r a d i t i o n a l o u t p a t i e n t p s y c h o t h e r a p i s t s w i t h such p a t i e n t s has y i e l d e d an overwhelmingly dismal pat-t e r n of treatment outcomes, (p. x i ) . That p r o f e s s i o n a l s tend to i n v o l v e parents as change agents f o r c h i l d r e n to a degree determined by theory, i n de-f i a n c e of f a c t , i s an a s s e r t i o n t h a t I f e e l i s d i s p u t a b l e ( R e i s i n g e r , Ora, and F r a n g i a , 1976). I t i s hoped t h a t c e r t a i n advantages to working with t h i s p o p u l a t i o n w i l l become apparent by l o o k i n g a t important s p e c i f i c s about the blue c o l l a r f a m i l y and a c e r t a i n s t y l e of treatment d e l i v e r y . Furthermore, an o u t l i n e of the combination of the s o c i a l l e a r n i n g approach and the treatment method f o r the blue c o l l a r f a m i l y i s proposed. C h a r a c t e r i s t i c s of the Blue C o l l a r Family Blue C o l l a r C h a r a c t e r i s t i c s (Riessman, 1962; Skynner, 1976; T r o t t e r , 1977; Minuchin, 1967, 1964). 26 That the t h e r a p i s t and h i s c l i e n t are congruent i n t h e i r goals and how they are to be achieved i s an important t h e r a -p e u t i c r u l e . By working with a p o p u l a t i o n whose c h a r a c t e r i s -t i c s s u i t the t h e r a p i s t ' s i n t e r v e n t i o n s t y l e we can achieve t h i s t h e r a p e u t i c r u l e . The blue c o l l a r f a m i l y possesses many unique c h a r a c t e r i s t i c s which suggest s t y l e of therapy o r i n t e r -v e n t i o n . These c h a r a c t e r i s t i c s were o r i g i n a l l y d i v i d e d i n t o two broad and o v e r l a p p i n g c a t e g o r i e s o f f a m i l y s t r u c t u r e and f a m i l y c u l t u r e . They have been combined below i n t o one l i s t w i th an a b s t r a c t i o n of the more important p o i n t s . a) There i s an o v e r a l l atmosphere o f impermanence, un-r e l i a b i l i t y and i n c o n s i s t e n c y , l i t t l e o r no c l e a r r u l e s to i n t e r n a l i z e e x i s t , and th e r e i s a minimum o f enduring s t r u c -t u r e . However, the blu e c o l l a r f a m i l y p r e f e r s s t r u c t u r e and o r g a n i z a t i o n to a r e l a x e d and ambiguous s i t u a t i o n . b) Because of the l a c k o f s t r u c t u r e and r u l e s the c h i l d -ren are f o r c e d t o r e a c t to f l u c t u a t i n g p a r e n t a l moods. c) T h e i r vocabulary and t h e i r c a p a c i t y f o r a b s t r a c t t h i n k i n g i s meager. There i s more o f a work and a c t i o n o r i e n -t a t i o n r a t h e r than a v e r b a l o r i e n t a t i o n . d) Because blue c o l l a r parents are d y s f u n c t i o n a l i n the way they r e a c t to t h e i r c h i l d r e n ' s behavior a d e f i c i t y i s c r e a t e d r e g a r d i n g the c h i l d ' s awareness of h i s impingement on o t h e r s . T h i s has broader i m p l i c a t i o n s f o r i t exposes a l i m i t e d awareness o f these f a m i l i e s i n regard to t h e i r own f u n c t i o n i n g , t h e i r s t r e n g t h s , t h e i r weaknesses, and how they r e l a t e to oth e r people. LEAF 27 OMITTED IN PAGE NUMBERING, 28 e) The emphasis o f these f a m i l i e s i s on c o n t r o l , author-i t y , and i n h i b i t i o n r a t h e r than on t e a c h i n g o r guidance. f) Blue c o l l a r f a m i l i e s are u s u a l l y s e l f - p e r p e t u a t i n g f a m i l i e s i n t h a t the parents f u n c t i o n p o o r l y i n c h i l d manage-ment s k i l l s because they a l s o had backgrounds where t h e i r p a r e n t a l examples o r r o l e models were d y s f u n c t i o n a l . g) The blue c o l l a r f a m i l y focuses on the p r e s e n t more than the p a s t o r the f u t u r e . h) C u l t u r a l l y , the b l u e c o l l a r f a m i l y i s very f a m i l y and group o r i e n t a t e d but p r e f e r l e s s i n t e n s e r e l a t i o n s h i p s o u t s i d e o f the f a m i l y . Blue C o l l a r Family - Method of Treatment I n v e s t i g a t o r s have s t u d i e d the problem of the high drop-out r a t e among l o w e r - c l a s s p a t i e n t s ( O v e r a l l and Aronson, 196 3). G e n e r a l l y , they have found t h a t problems e x i s t i n the d i f f e r e n t types of treatment not b e i n g t a i l o r e d to the charac-t e r i s t i c s o f the c l i e n t . Mayer and Timms (1969) note: C l e a r l y treatment e f f e c t i v e n e s s w i l l i n c r e a s e when case-work p r a c t i o n e r s , r e s e a r c h e r s , and mental h e a l t h p e r s onnel i n general give more thought and a t t e n t i o n to the outlook of c l i e n t s (p. 32). U n d e r l y i n g the s u i t a b i l i t y of the s o c i a l l e a r n i n g approach to the blue c o l l a r f a m i l y i s the concept t h a t t h i s p o p u l a t i o n i s most amenable to a p r e s c r i p t i v e type o f i n t e r v e n t i o n (McMahan, 1962). That i s , they are more respon s i v e to a t h e r a -py whose emphasis l i e s i n p r a c t i c a l a c t i o n r a t h e r than i n s i g h t . As Gould (1967) notes, the t h e r a p i s t ' s f i r s t duty i s to add-r e s s the problem presented by the f a m i l y . The blue c o l l a r f a m i l y looks to the t h e r a p i s t as a p r o f e s s i o n a l who i s e i t h e r going to address d i r e c t l y t h e i r immediate concern o r i s going to p r e s c r i b e f o r them a way t h a t they themselves can e l i m i n a t e the problem ( O v e r a l l and Aronson, 1963). O v e r a l l and Aronson (196 3) l i s t three areas they d i s c o v e r e d to be important f a c t o r s r e l a t e d to blue c o l l a r dropout. a) Lower-class c l i e n t s g e n e r a l l y expect a s p e c i f i c p a t -t e r n or s t y l e of i n t e r v i e w from the t h e r a p i s t . An ambiguous, n o n - d i r e c t i v e , v e r b a l format i s u s u a l l y not b e s t when t r e a t i n g a b l u e c o l l a r c l i e n t . b) E a r l y i n the treatment or i n the i n i t i a l i n t e r v i e w i t i s u s u a l l y a good i d e a to re-educate the blue c o l l a r c l i e n t as to both h i s r o l e and the t h e r a p i s t ' s r o l e i n the f u t u r e treatment. c) The t h e r a p i s t should encourage the d i r e c t e x p r e s s i o n o f the e x p e c t a n c i e s o f the blue c o l l a r c l i e n t . Skynner (1976) echoes the r e s e a r c h f i n d i n g s o f o t h e r s when he says t h a t a b s t r a c t Rogerian, c o n c e p t u a l techniques are r e l a t i v e l y i n e f f e c t i v e i n working with a b l u e c o l l a r popula-t i o n . He b e l i e v e s t h a t the s t r u c t u r e of the f a m i l y must be a d j u s t e d by c o n c r e t e means. For example, Skynner says t h a t c h i l d r e n of b l u e c o l l a r f a m i l i e s should respond p o s i t i v e l y to behavior c o n t r a c t i n g because o f the l a c k of c o n s i s t e n t s t r u c t u r e o r coherent r u l e s to i n t e r n a l i z e . Furthermore, b e h a v i o r a l techniques such as c o n t r a c t i n g n a t u r a l l y l e n d themselves to the e x t e r n a l focus of such f a m i l i e s . Minuchin (1966) s t a t e s : 30 T h i s i s our most s e r i o u s problem i n a c t i n g - o u t f a m i l i e s . They are u n s k i l l e d i n i n t r o s p e c t i o n -i n o b s e r v i n g and e v a l u a t i n g t h e i r own a c t i o n s -and r e q u i r e a therapy t h a t c e n t e r s on ways o f making t h i s process more a v a i l a b l e to them (p. 613) . A S p e c i f i c Treatment Approach The c h a r a c t e r i s t i c s of the blue c o l l a r f a m i l y can suggest s p e c i f i c t h e r a p e u t i c treatment approaches which are e s p e c i a l l y s u i t e d f o r t h i s p o p u l a t i o n . Two such approaches to treatment are those proposed by Gould (1967) and Skynner (1976). The two approaches have been combined and appear below as one. a) There i s a c r i s i s o r i e n t a t i o n or a focus c l e a r l y on the p r e s e n t i n g problem. The t h e r a p i s t d i r e c t s h i s energy t o -wards the s p e c i f i c area o f concern t h a t the f a m i l y b r i n g s to him. b) An i n t e r v i e w i n g atmosphere of i n f o r m a l i t y i s c r e a t e d wherein the c l i e n t i s made to f e e l as comfortable and r e l a x e d as p o s s i b l e . The a p p r o p r i a t e use o f simple communication v o i d of fancy p r o f e s s i o n a l jargon i s of trememdous importance. c) E s t a b l i s h i n g c o n t a c t with the c l i e n t on a nonverbal l e v e l , b e i n g more p h y s i c a l i n d e s c r i p t i o n s and conducting therapy where i t i s most a p p r o p r i a t e and comfortable f o r the c l i e n t are a l l important. T h i s leads to an (atmosphere) em-p h a s i s upon 'reaching out' through home v i s i t s , s c h o o l v i s i t s and phone c a l l s . d) I n t e r v e n t i o n w i t h a blue c o l l a r p o p u l a t i o n i s u s u a l l y more e f f e c t i v e when i t i s s h o r t term, 6-12 weeks. 31 e) The e x t e n s i v e use of the techniques of r o l e - p l a y i n g , m o d e l l i n g and b e h a v i o r a l r e h e a r s a l are important. f) An education o r i e n t a t i o n i s u s u a l l y more e f f e c t i v e than an i n t e l l e c t u a l , a n a l y t i c , e x p l a n a t o r y or v e r b a l approach. T h i s type of format i s a l s o a p p r o p r i a t e because sometimes the c l i e n t simply does not know what a p p r o p r i a t e b e h a v i o r s are necessary. g) The approach i s based on a d i r e c t i v e or a u t h o r i t a r i a n d e l i v e r y i n the e a r l y stages. Most f a m i l i e s expect d i r e c t i o n and put themselves t r u s t i n g l y i n the t h e r a p i s t ' s hands. The t h e r a p i s t must l e a r n to take c o n s t r u c t i v e advantage o f t h i s dependence. h) The approach should be based on. the v a l u e s , needs and d e s i r e s o f the c l i e n t , r a t h e r than those o f the t h e r a p i s t . i ) I t i s s u p p o r t i v e i n t e r v e n t i o n due to some low s e l f -esteem o f the c l i e n t . Encouragement and p o s i t i v e l y phrased language are used u n s p a r i n g l y . The Blue C o l l a r Family and the Behavior  M o d i f i c a t i o n Approach By l o o k i n g at the b l u e c o l l a r f a m i l y s t r u c t u r e , t h e i r c u l t u r e , and 0 ' D e l l ' s (19 74) c o n c l u s i o n s about t r a i n i n g parents i n b ehavior therapy techniques, s p e c i f i c treatment approaches to the b l u e c o l l a r f a m i l y n a t u r a l l y emerge. Approaches, such as Gould's and Skynner's, are t a i l o r e d t o the blue c o l l a r p o p u l a t i o n . The almost p e r f e c t f i t of these treatment approach-es and the b e h a v i o r m o d i f i c a t i o n or s o c i a l l e a r n i n g approach i s r e a l l y where the advantages of u s i n g the proposed approach outweigh the disadvantages. I t i s proposed t h a t i f one uses these treatment approaches which are d e r i v e d from the f a m i l y s t r u c t u r e and c u l t u r e of the blue c o l l a r f a m i l y , then the b e s t theory o r technique o f therapy to be used i n treatment appears to be the behavior m o d i f i c a t i o n approach. The b e h a v i o r m o d i f i c a t i o n approach f o r the treatment of the d y s f u n c t i o n a l blue c o l l a r f a m i l y i s probably the b e s t approach because: a) The b e h a v i o r a l approach i s very p r e s c r i p t i v e , d i r e c t and unambiguous i n i t s approach. There are s p e c i f i c steps and g u i d e l i n e s to f o l l o w . b) The b e h a v i o r a l approach i s a s h o r t term approach i n v o l v i n g u s u a l l y no more than 6 weeks o f treatment. (Note: the proposed model i n v o l v e s no more than approximately 6 weeks of treatment.) c) The b e h a v i o r a l approach emphasizes p r a c t i c a l a c t i o n with c o n c r e t e and e a s i l y understandable i n t e r v e n t i o n s t e p s ; n o n - i n s i g h t o r i e n t a t e d , non-verbal emphasis. d) The t h e r a p i s t i s symptom o r i e n t a t e d and addresses the p r e s e n t i n g problem o f the f a m i l y f i r s t r a t h e r than, per-haps, a v o i d i n g t h i s and going on to more of what he sees as the problem (eg. m a r i t a l problems). e) The r o l e s o f the p a r e n t ( s ) , the problem c h i l d and the t h e r a p i s t are made e x p l i c i t from the very beginning of i n t e r -v e n t i o n . 33 f) The b e h a v i o r a l approach addresses d i r e c t l y the l a c k o f s t r u c t u r e i n an u n s t r u c t u r e d home environment. The b e h a v i o r a l approach can b e t t e r o r g a n i z e the blue c o l l a r household. g) The b e h a v i o r a l approach uses home v i s i t s , s c hool v i s i t s , and phone c a l l s i n p r a c t i c a l l y a l l stages o f i n t e r v e n -t i o n . Such a s t y l e o f reaching-out reduces the f o r m a l i t y o f the t h e r a p i s t / c l i e n t r e l a t i o n s h i p and consequently reduces ' r o l e d i s t a n c e ' and f a c i l i t a t e s the open and honest e x p r e s s i o n of e x p e c t a n c i e s i n treatment by the p a r e n t ( s ) . h) R o l e - p l a y i n g and contingency c o n t r a c t i n g are b a s i c to a b e h a v i o r a l therapy approach and are most a p p r o p r i a t e w i t h a blue c o l l a r f a m i l y (Gould, 1967; Skynner, 1976). i ) For the most p a r t , the format o f a b e h a v i o r a l approach i n the home i s e d u c a t i o n a l . j) The focus of behavior m o d i f i c a t i o n i s on the here-and-now and p r i m a r i l y addresses i t s e l f to o v e r t problem be-h a v i o r s t h a t are happening now and can be d e f i n e d i n c l e a r o p e r a t i o n a l terms. k) The t h e r a p i s t communicates to the f a m i l y a t a l e v e l which can be understood w i t h a minimum o f p r o f e s s i o n a l jargon. 1) Encouragement and reinforcement of the parents by the t h e r a p i s t d u r i n g a l l phases of treatment i s o f primary impor-tance t o t h i s treatment approach (Tharp and Wetzel, 1969). 34 Chapter I I I The Model  I n t r o d u c t i o n Chapter I I concluded w i t h a review o f r e s e a r c h p r o p o sing a behavior m o d i f i c a t i o n approach to working with b l u e c o l l a r f a m i l i e s . T h i s was the r e s u l t o f a s e r i e s o f i n v e s t i g a t i o n s c o v e r i n g three main areas; a) behavior m o d i f i c a t i o n approach, b) use o f parents as change agents f o r t h e i r c h i l d r e n , and c) c h a r a c t e r i s t i c s o f the blue c o l l a r f a m i l y . Chapter I I I w i l l examine how the b e h a v i o r a l approach can be strengthened by combining i t w i t h another important t h e r a -p e u t i c o r i e n t a t i o n , t h a t o f Rogers (1951) or Carkhuff (1967). A p s y c h o - b e h a v i o r a l (Woody, 1971) i n t e r v e n t i o n s t y l e w i l l a l s o be examined and a treatment model, combining the t h e o r e t i c a l foundation o f Chapter I I , w i l l be o u t l i n e d . I t i s becoming i n c r e a s i n g l y c l e a r from both t h e o r e t i c a l and r e s e a r c h p e r s p e c t i v e s t h a t one t h e r a p e u t i c approach cannot be s u c c e s s f u l l y a p p l i e d to any type of c l i e n t e x h i b i t i n g any type of problem. One approach the l o g i c o f Chapter II has taken i s t h a t what the t h e r a p i s t does i n h i s o r her i n t e r v e n -t i o n s t y l e must make sense to the c l i e n t . Woody (1971) s t a t e s : ... c o u n s e l o r - t h e r a p i s t s should be prepared, f o r the good of t h e i r c l i e n t s , to escape the c o n f i n e s o f a s i n g l e t h e o r e t i c a l approach o r s e t of techniques, and to t a i l o r t h e i r p r o f e s s i o n a l a c t i o n s to the needs and c h a r a c t e r i s t i c s o f the c l i e n t being t r e a t e d (p. 8). 35 T h e b e h a v i o r m o d i f i c a t i o n a p p r o a c h h a s b e e n p r o p o s e d a s a n e s -p e c i a l l y s u i t a b l e i n t e r v e n t i o n s t y l e f o r t h e b l u e c o l l a r f a m -i l y i n d e a l i n g w i t h f a m i l y p r o b l e m s c e n t e r i n g a r o u n d t h e i r c h i l d r e n . H o w e v e r , i t a p p e a r s f r o m m y c l i n i c a l e x p e r i e n c e a n d t h e r e s e a r c h o f o t h e r s t h a t o n e s k i l l w h i c h t h e b e h a v i o r t h e r a -p i s t s h o u l d e f f i c i e n t l y i n c o r p o r a t e i n t o h i s o r h e r r e p e r t o i r e o f s k i l l s i s t h e e f f e c t i v e u s e o f t h e t h e r a p e u t i c r e l a t i o n s h i p . ' B e h a v i o r t h e r a p i s t s , s u c h a s T h a r p a n d W e t z e l ( 1 9 6 9 ) , s t a t e : T h e a b i l i t y t o f o r m o p e n , t r u s t i n g a n d a c c u r a t e r e -l a t i o n s h i p s i s o f a v a l u e a s g r e a t i n c o n t i n g e n c y m a n a g e m e n t a s i n p s y c h o t h e r a p y ; r a p p o r t a n d e m p a t h y w i l l s e r v e t h e c o n t i n g e n c y m a n a g e r w e l l i n h i s e f f o r t s t o u n d e r s t a n d t h e c o m p l e x a r t i c u l a t i o n o f a s o c i a l e n v i r o n m e n t ( p . 2 4 ) . T h e T h e r a p e u t i c R e l a t i o n s h i p A s p r e s e n t e d i n C h a p t e r I I t h e b e h a v i o r m o d i f i c a t i o n a p p r o a c h c o n t a i n s i m p o r t a n t d i s a d v a n t a g e s . A m o n g t h e s e a r e t w o t h a t a d d r e s s t h e m s e l v e s t o a c r i t i c a l d i f f e r e n c e , b e t w e e n b e h a v i o r t h e r a p y a n d R o g e r i a n t h e r a p y : a ) B e h a v i o r t h e r a p y f o r t h e m o s t p a r t i g n o r e s t h e r e l a -t i o n a l f a c t o r s i n c r e a t i n g a c o n d u c i v e t h e r a p e u t i c a t m o s p h e r e f o r t h e c l i e n t a n d t h e t h e r a p i s t ; t h e r e i s a m e c h a n i c a l a n d n o n h u m a n i s t i c l e v e l o f i n t e r c h a n g e . b ) B e h a v i o r t h e r a p y u s u a l l y f o c u s e s o n l y o n b e h a v i o r a n d d o e s n o t f o c u s u p o n t h e c l i e n t ' s f e e l i n g s . T h a t m o s t b e h a v i o r t h e r a p i s t s h a v e , i n t h e p a s t , i g n o r e d t h e r e l a t i o n s h i p f a c t o r s b e t w e e n t h e m s e l v e s a n d t h e i r c l i e n t s a n d h a v e n o t f o c u s e d u p o n t h e i r c l i e n t ' s f e e l i n g s h a s b e e n 36 w e l l documented (P a t t e r s o n , 1973; Wilson and Evans, 1977). The importance or unimportance o f the c l i e n t - t h e r a p i s t r e l a t i o n s h i p i n the i n t e r v e n t i o n s t y l e of a t h e r a p i s t t r a i n e d i n b e havior m o d i f i c a t i o n has been a p o i n t o f long s t a n d i n g c o n t r o v e r s y . Wolpe (19 58) conceded t h a t as much as 60 pe r c e n t o f the e f f e c t i v e n e s s o f behavior m o d i f i c a t i o n may be due to ' n o n - s p e c i f i c r e l a t i o n s h i p f a c t o r s ' . Research today, f o r the most p a r t , supports Wolpe's e a r l y p o s i t i o n . However, the r e -l a t i o n s h i p factors- t h a t Wolpe spoke of are today q u i t e i d e n t i -f i a b l e and s p e c i f i c (Carkhuff and Berenson, 1967). The d e f i n e d dimensions should be present i n the t h e r a p e u t i c r e l a t i o n s h i p i f the therapy i s to be as e f f e c t i v e as p o s s i b l e . Much o f the evidence seems i n d i s p u t a b l e . Woody (1971) takes the i s s u e one step f u r t h e r when he notes: Of s p e c i a l importance i s the p o s s i b i l i t y t h a t these p a r t i c u l a r dimensions c o u l d , a t l e a s t i n p a r t , depend on p e r s o n a l c h a r a c t e r i s t i c s as much or more than on p r o f e s s i o n a l c h a r a c t e r i s t i c s (p. 7). That the t h e r a p e u t i c r e l a t i o n s h i p i s o f g r e a t importance i n the o v e r a l l t h e r a p e u t i c encounter i s a p o i n t t h a t appears to be no lon g e r debatable ( G o l d s t e i n , 1962). Indeed, s e r i o u s c o n s i d e r a t i o n i s now being given by many behavior t h e r a p i s t s to the importance of the t h e r a p i s t - c l i e n t r e l a t i o n s h i p i n t h e i r work (Woody, 1971; P a t t e r s o n , 1973; Sloane, S t a p l e s e t a l , 1975). There appears today to be a camp of b e h a v i o r i s t s forming what i s somewhat analogous to the f i r s t Neo-Freudians; A d l e r , Jung, and Rank. That i s , these b e h a v i o r i s t s are d i s -agreeing with the 'pure' S k i n n a r i a n b e h a v i o r i s t s and t h e i r s t r i c t l e a r n i n g theory approach and they are i n c o r p o r a t i n g 37 i n t o t h e i r t h e r a p e u t i c r e p e r t o i r e the f a c i l i t a t i v e c o n d i t i o n s of the t h e r a p e u t i c r e l a t i o n s h i p ; namely those c o n d i t i o n s o f accurate empathy, u n c o n d i t i o n a l p o s i t i v e regard, and genuiness (Rogers, 1951; Carkhuff and Berenson, 1967). Mickelson and S t e v i c (1971) agree with C a r k h u f f ' s (1967) c o n c l u s i o n t h a t maximum b e n e f i t s from any behavior m o d i f i c a t i o n program must have as a p r e - r e q u i s i t e high l e v e l s o f i n t e r p e r s o n a l f u n c t i o n -i n g e x h i b i t e d by the t h e r a p i s t . Other r e s e a r c h e r s , such as Pa t t e r s o n (19 73) and Hammond, Hepworth and Smith (19 77) a l s o p o i n t to the evidence t h a t c e r t a i n a t t r i b u t e s of the t h e r a p i s t have a r e i n f o r c i n g e f f e c t on the c l i e n t . P a t t e r s o n c a l l s them r e s p e c t , i n t e r e s t , concern, and a t t e n t i o n . Lazarus (1968), perhaps, b e s t sums up the re l e v a n c e o f the p o s i t i o n o f the t h e r a p e u t i c r e l a t i o n s h i p i n behavior therapy when he notes t h a t n o t h i n g i n l e a r n i n g theory p r e c l u d e s the behavior t h e r a -p i s t from o f f e r i n g , 'human understanding, empathy, support, and o t h e r f a c t o r s t h a t f o s t e r hope and mobolize an e x p e c t a t i o n of h e l p ' . In a l a r g e r e s e a r c h study by Sloane, S t a p l e s , C r i s t o l , Yorkston and Whipple (1975) e n t i t l e d Psychotherapy Versus  Behavior Therapy the authors undertook the task o f experiment-a l l y comparing behavior therapy and psychotherapy. Three groups o f c l i e n t s , one a c o n t r o l group, were t r e a t e d by be-h a v i o r t h e r a p i s t s o r p s y c h o t h e r a p i s t s . Of the authors' s i x g e n e r a l c o n c l u s i o n s from the study, two d i r e c t l y address themselves to the i s s u e o f the therapeu-t i c r e l a t i o n s h i p . F i r s t , i t was noted t h a t the s t y l e s o f the two 38 types o f t h e r a p i s t s d i f f e r e d d r a m a t i c a l l y . The be h a v i o r t h e r a -p i s t s were more a c t i v e than the p s y c h o t h e r a p i s t s and more f r e q u e n t l y gave e x p l i c i t i n s t r u c t i o n s and ad v i c e . They p r e -sented t h e i r own value judgements, p r o v i d e d i n f o r m a t i o n , domin-ated the c o n v e r s a t i o n v e r b a l l y and c o n t r o l l e d the content o f the c o n v e r s a t i o n . Furthermore, they achieved a deeper l e v e l o f i n t e r - p e r s o n a l c o n t a c t and empathy than d i d the more p a s s i v e p s y c h o t h e r a p i s t s . Behavior t h e r a p i s t s , besides being seen by t h e i r c l i e n t s as more genuine persons, were a l s o p i c t u r e d as encouraging l e s s independence than the p s y c h o t h e r a p i s t s (Sloane e t a l , 1975). Secondly, the r e s e a r c h i n d i c a t e d t h a t the c r u c i a l i n d i c a t o r f o r s u c c e s s f u l psychotherapy, as w e l l as behavior therapy, was the t h e r a p i s t - c l i e n t r e l a t i o n s h i p . The c l i e n t s from both behavior therapy and psychotherapy saw the s i n g l e most important, f a c t o r of t h e i r treatment as being t h e i r p e r s o n a l i n t e r a c t i o n w i t h the t h e r a p i s t . Combining Behavior Therapy and Aspects of the Ther a p e u t i c R e l a t i o n s h i p P a t t e r s o n (1973) b e l i e v e s Thome's (1973) e c l e c t i c i s m has one major weakness. P a t t e r s o n f e e l s Thorne f a i l s to s u c c e s s f u l l y i n t e g r a t e the two major schools o f therapy, c l i e n t -c e n t e r e d therapy and behavior therapy. Woody (19 71), on the o t h e r hand, i n h i s book Psychobehavioral C o u n s e l l i n g and  Therapy - I n t e g r a t i n g B e h a v i o r a l and I n s i g h t Techniques, has t r i e d to do what P a t t e r s o n says Thorne has f a i l e d to do. Woody d e s c r i b e s p s y c h o b e h a v i o r a l c o u n s e l l i n g and therapy as a " t e c h n i c a l e c l e c t i c i s m ' t h a t e f f e c t i v e l y combines Rogerian and c o n d i t i o n i n g techniques and r e l e g a t e s the r o l e of the person c h i e f l y r e s p o n s i b l e f o r the t h e r a p e u t i c a c t i o n to the t h e r a p i s t and not to the c l i e n t as some p s y c h o t h e r a p i s t s might. The t h e r a p i s t p r o v i d e s what G o l d s t e i n (19 73) r e f e r s to as s o c i a l c l a s s - r e l e v a n t techniques or p r e s c r i p t i v e psychotherapy and not ' t h e r a p e u t i c shotguns 1. T h i s appears to address the i s s u e of the blue c o l l a r f a m i l y and the e f f e c t i v e combination o f b e h a v i o r a l and i n s i g h t techniques. I t i s proposed t h a t probably one of the most e f f e c t i v e s t y l e s o f i n t e r v e n t i o n f o r the blue c o l l a r p o p u l a t i o n i s a combination of the two. O v e r a l l , t h e : t h e r a p i s t s would e x h i b i t empathy, genuiness and p o s i t i v e regard f o r h i s or her c l i e n t s . On the ot h e r hand, they would a l s o r e c o g n i z e t h a t i n s i g h t was not the b a s i c goal. o f the therapy but t h a t c e r t a i n pre-agreed upon b e h a v i o r a l goals were. A d d r e s s i n g the t o p i c o f c l i e n t i n s i g n t i n therapy, Hammon, Hepworth and Smith (19 75) note: . . . i n s i g h t should be pursued o n l y as f a r as i t i s e s s e n t i a l to removing the b a r r i e r s to change. The c o u n s e l l o r s e t h i c a l r e s p o n s i b i l i t y i s to a s s i s t c l i e n t s as r a p i d l y as p o s s i b l e , and i n some i n s t a n c e s , l i t t l e i n s i g h t i s r e q u i r e d b e f o r e the c l i e n t can undertake c o r r e c t i v e a c t i o n s (p. 50). Improvement i n the proposed s t y l e of t h e r a p e u t i c i n t e r v e n t i o n would not be r e f l e c t e d i n the amount of s e l f - u n d e r s t a n d i n g t h a t the c l i e n t achieved. T h i s , i n most cases, would be a s t r i c t Rogerian or i n s i g h t view o f c l i e n t improvement. B e h a v i o r i s t s see the b e n e f i c i a l c o g n i t i v e and emotional changes t h a t can occur from therapy as byproducts o f beh a v i o r change ( G l a s s e r , 1965; Hammond, Hepworth, and Smith, 1975). 40 I t i s hoped t h a t by making the blue c o l l a r c l i e n t some-what aware of the b a r r i e r s t h a t impede h i s change, u s i n g a Rogerian s t y l e o f i n t e r a c t i o n o r e f f e c t i v e use o f the t h e r a -p e u t i c r e l a t i o n s h i p , the t h e r a p i s t can a s s i s t the c l i e n t to hu r d l e the b a r r i e r s to change by concrete b e h a v i o r a l i n t e r v e n t i o n techniques. T h i s i s the combination o f the two types o f t h e r a -p i e s t h a t I e n v i s i o n . U n d e r l y i n g the b e h a v i o r i s t p o s i t i o n on i n s i g h t i s what Hammond, Hepworth, and Smith (1975) see as the 'Spread o f E f f e c t ' phenomenon. The spread o f e f f e c t phenomenon r e f e r s to a c l i e n t who a f t e r making c o n s i d e r a b l e progress with h i s o r i g i n a l p r e s e n t i n g problem gains the s k i l l and confidence to dea l w i t h o t h e r home problems on h i s or her own. The v a l u a b l e p r e v e n t i v e overtones o f t h i s are obvious. The o v e r a l l i n t e r v e n t i o n s t y l e f o r the blue c o l l a r f a m i l y would be based on the f o l l o w i n g g u i d e l i n e s : 1) behav-i o r a l emphasis, 2) short-term i n t e r v e n t i o n , 3) a u t h o r i t a t i v e , a d m i n i s t r a t i o n 4) e a r l y , c o n t i n u i n g , and frequent reinforcement and encouragement ( G o l d s t e i n , 1973), and 5) empathy, uncondi-t i o n a l p o s i t i v e regard and genuiness e x h i b i t e d towards the c l i e n t a t a l l times. A Proposed A l t e r n a t i v e Treatment Model I n t r o d u c t i o n The proposed treatment model f o r working w i t h a blue c o l l a r f a m i l y i n v o l v e s a c o l l a g e o f t h e r a p e u t i c techniques. 41 The model i s designed not o n l y to educate the blue c o l l a r p a rent i n p r i n c i p l e s and techniques o f behavior m o d i f i c a t i o n but to a l s o i n t e g r a t e r e l a t e d aspects o f h u m a n i s t i c a l l y o r i e n t e d approaches, s p e c i f i c a l l y the e f f e c t i v e use of the t h e r a p e u t i c r e l a t i o n s h i p . S a d l e r and Seyden (1975) see the combination of the b e s t o f both the behavior m o d i f i c a t i o n and the humanistic approaches as o f f e r -i n g an i d e a l combination i n a w e l l - o r g a n i z e d parent t r a i n i n g course. The f o l l o w i n g model i s an o u t l i n e of what I c o n s i d e r to be an e f f e c t i v e s t y l e of i n t e r v e n t i o n w i t h the blue c o l l a r f a m i l y . The model i s the r e s u l t of my c l i n i c a l experience and a review of the r e l a t e d r e s e a r c h and l i t e r a t u r e . Furthermore, apparent gaps i n p r e v i o u s models have been examined. There are s i x d i s -t i n c t components to the model w i t h v a r i o u s s u b s e c t i o n s to each. The s i x components are; A. Assessment 1) . R o l e - I n d u c t i o n Interview 2) .- Intake Interview 3) . B a s e l i n e B. Treatment 4) . Parent T r a i n i n g Sessions 5) . Assessment of Change C. E v a l u a t i o n 6) . C o n s u l t a t i v e Follow-up T h i s model should not be f o l l o w e d o r i n t e r p r e t e d as i f i t were a step-by-step 'program' but r a t h e r as an o u t l i n e f o r i n -t e r v e n t i o n w i t h the blue c o l l a r f a m i l y e x h i b i t i n g d i f f i c u l t i e s i n dealing with children of pre-school or elementary school age. F i n a l l y , the following model attempts to address Carkhuff's (1971) c r i t e r i a for a comprehensive program for parent t r a i n i n g . In Carkhuff's c r i t e r i a , which appear below, the integration of the behavioral and insight approaches i s evident again. 1) . Training in the interpersonal and other s k i l l s necessary to function e f f e c t i v e l y . 2) . Training i n the methods of discerning and developing e f f e c t i v e courses of action. 3) . Training i n the means and modalities necessary to implement the resultant programs. (Carkhuff, 1971, p. 12). A. Assessment A.1. Role-Induction Interview The role-induction interview (Hoehn-Saric et a l , 1964) i s the f i r s t interview the therapist has with the parents. This interview i s c r i t i c a l for two reasons. F i r s t , i n t h i s i n t e r -view the therapist should try to discern the o v e r a l l motivation or readiness of the parents for the counselling program and he should also come to some conclusions as to the commitment of the parents towards the program. Some researchers see the c l i e n t ' s motivational l e v e l as being the single most c r u c i a l factor r e l a t i n g to successful therapy outcomes (Ripple, 1964). Kuchenmuller (19 75), i n his research, recently concluded that the importance of an evaluation of the parent's and the c h i l d -ren's readiness and commitment to enter a concentrated behavior 43 modification program cannot be underestimated. Hammond, Hep-worth, and Smith (19 7 7) state: E f f o r t s to continue counselling with an inadequately motivated c l i e n t are generally doomed to f a i l u r e (p. 41) . Hammond, et a l , (1977) go on to say that almost any c l i e n t ' s motivation to carry on i n therapy centers around his or her ex-perience i n looking the therapist over during the very f i r s t interview. By the therapist being sensitive to the importance of the role-induction interview he or she w i l l be rewarded with c l i e n t s who stay longer i n therapy and do not prematurely t e r -minate (Hoehn-Saric et a l , 1964). The second major importance of the role-induction interview concerns i t s e l f with how t h i s f i r s t interview got i t s name. That i s . The second important function of t h i s interview i s that i t should be used by the therapist to discuss any e x i s t i n g thera-p i s t - c l i e n t role ambiguities. With the blue c o l l a r c l i e n t there i s usually a large degree of covert disagreement as to how the therapy w i l l proceed (Mayer and Timms, 1969). In most instances Mayer and Timms (1969) discovered that the blue c o l l a r c l i e n t was ... almost t o t a l l y unaware that, the therapist' s approach to therapy d i f f e r e d dramatically from his own. ...two persons ostensibly playing the same game but actually adhering to rules that are private (Mayer and Timms, 1969, p. 37). Role-induction i s what Goldstein (19 73) would re f e r to as a technique for ambiguity reduction. The therapist should take time to c l a r i f y for the blue c o l l a r parent what his or her s t y l e of therapy i s l i k e and why i t i s l i k e that. Furthermore, 44 an atmosphere where the c l i e n t f e e l s he can o f f e r some genuine feedback o f h i s o r her own e x p e c t a t i o n s from the t h e r a p i s t should always be c r e a t e d by the t h e r a p i s t u s i n g h i s humanistic s k i l l s . Role e x p e c t a t i o n s i n therapy a l s o i n v o l v e p r o g n o s t i c ex-p e c t a n c i e s . With the blue c o l l a r c l i e n t t h i s i s e s p e c i a l l y important f o r u s u a l l y the l o w e r - c l a s s c l i e n t e n t e r s therapy ex-p e c t i n g a g r e a t d e a l o f change or help w h i l e , on the o t h e r hand, the t h e r a p i s t holds low p r o g n o s t i c hopes f o r t h i s type of c l i e n t ( G o l d s t e i n , 1973). F i n a l l y , the r o l e - i n d u c t i o n i n t e r v i e w i s a good time to prepare the c l i e n t f o r the many d i f f e r e n t emotional paths t h a t therapy can take. The t h e r a p i s t should a v o i d f r i g h t e n i n g the c l i e n t , but a t the same time be prepared to be honest with him about the p o s s i b l e p e r i o d s of sorrow and p a i n as w e l l as the times o f joy and p r o g r e s s . A. 2. Intake Interview The i n t a k e i n t e r v i e w i s , i n most cases, the f i r s t i n t e r -view the t h e r a p i s t has with the c l i e n t . Normally, the r o l e -i n d u c t i o n i n t e r v i e w would be subsumed under the heading of the i n t a k e i n t e r v i e w . The s e p a r a t i o n o f the two u n d e r l i n e s the importance o f the r o l e - i n d u c t i o n i n t e r v i e w when i t comes to d e a l i n g w i t h the blue c o l l a r parents who may l a c k i n under-standing and m o t i v a t i o n . However, i f the t h e r a p i s t can e a s i l y see t h a t the parents are ready and motivated to begin the. pro-gram and t h a t they understand the d i r e c t i o n that' the therapy w i l l take, then the t h e r a p i s t c o u l d combine the r o l e -i n d u c t i o n i n t e r v i e w with the i n t a k e i n t e r v i e w . 45 The i n t a k e i n t e r v i e w comes under the broad heading o f what some t h e r a p i s t s might r e f e r to as Assessment ( P a t t e r s o n , 1975). In the p r e s e n t model the R o l e - I n d u c t i o n Interview, Intake I n t e r -view, and B a s e l i n e a l l come under the heading of Assessment. P a t t e r s o n (19 75) and others see the i n t a k e i n t e r v i e w as a time f o r the t h e r a p i s t , the p a r e n t s , and the c h i l d to f a m i l i a r i z e themselves with each other as w e l l as having the parents and the c h i l d f i l l out v a r i o u s assessment forms. These assessment forms i n c l u d e background or h i s t o r i c a l data f o r the c l i n i c and the t h e r a p i s t as w e l l as t e s t s f o r the parents and the c h i l d designed to assess t h e i r s u i t a b i l i t y or n o n - s u i t a b i l i t y f o r c e r t a i n types of programs. Whether the parents and the c h i l d are i n t e r v i e w e d t o g e t h e r or s e p a r a t e l y the t h e r a p i s t i n h i s or her opening statements should t r y to convey to them a sense t h a t they are e n t e r i n g a program t h a t w i l l p r o v i d e f o r them a l l a time f o r p o s i t i v e change (Pat t e r s o n , 1975). Furthermore, the t h e r a p i s t should be c a r e f u l i n making sure t h a t h i s opening remarks address and i n c l u d e the whole f a m i l y . That i s , a f t e r the i n t a k e i n t e r v i e w the f a m i l y should go away w i t h the f e e l i n g t h a t they a l l w i l l c o n t r i b u t e to t h i s change process and t h a t the c h i l d i s not being brought to the t h e r a p i s t ' s o f f i c e to be ' f i x e d ' and then given back to the f a m i l y . Breakage Fee I f i t appears t h a t the f a m i l y i s s u i t a b l e f o r the proposed s t y l e of i n t e r v e n t i o n then the c o l l e c t i o n of a 'breakage f e e ' should be d i s c u s s e d next (Pa t t e r s o n , 1975). A breakage fee i s 46 a s m a l l amount of money t h a t i s c o l l e c t e d by the t h e r a p i s t be-f o r e the treatment has begun. The approach to the c o l l e c t i o n o f the breakage fee i s more of a f i r m suggestion by the t h e r a -p i s t t h a t needs the understanding c o o p e r a t i o n of the p a r e n t s . The amount v a r i e s w i t h the socio-economic l e v e l of the c l i e n t . In the case of the blue c o l l a r f a m i l y i t might be $10.00. The breakage fee i s used as a means o f 'motivating' the f a m i l y to keep appointments, do t h e i r homework and, i n g e n e r a l , cooperate as f u l l y as p o s s i b l e w i t h the t h e r a p i s t . Other means or methods o f i n d u c i n g c o o p e r a t i o n from lower-c l a s s parents have i n c l u d e d c h i n a ( R i s l e y , 1968), money ( P a t t e r -son, McNeal, Hawkins, P h i l p s , 196 7), and h a i r d r e s s i n g a p p o i n t -ments (P a t t e r s o n , Reid, 19 70). For example, when appointments are missed, without a good excuse or p r i o r n o t i f i c a t i o n , the t h e r a p i s t c o u l d deduct $2.00 from the parent's breakage fee. S i m i l a r deductions would occur f o r other s e r i o u s types of un-cooperative f a m i l y b e h a v i o r . I f , on the o t h e r hand, the parents and the c h i l d are r e l a t i v e l y c o n s i s t e n t i n t h e i r r e s p e c t i v e r e s p o n s i b i l i t i e s i n the treatment program the f u l l amount of t h e i r breakage fee i s r e t u r n e d to them a t the end o f the treatment. The breakage fee serves two purposes. One, i t helps to ensure t h a t the parents w i l l cooperate w i t h the t h e r a p i s t i n b eing r e s p o n s i b l e f o r the t a s k s a s s i g n e d to them. Secondly, i t conveys e a r l y i n the program an i n t r o d u c t i o n to a s o c i a l l e a r n i n g type o f approach by making c e r t a i n behaviors o f the parent's c o n t i n g e n t upon t h e i r breakage fee being r e t u r n e d . 47 I n i t i a l B e h a v i o r a l O r g a n i z a t i o n Once the breakage fee has been worked out with the parents i t i s time to begin p i n p o i n t i n g some s p e c i f i c behaviors o f the problem c h i l d t h a t have brought the parents i n seeking h e l p . Each parent i s i n s t r u c t e d to make a l i s t of both negative and p o s i t i v e behaviors t h a t the c h i l d e x h i b i t s . I t cannot be emphasized enough t h a t each parent's l i s t s hould c o n t a i n s p e c i -f i c b e h a v i o r s ; a c t i o n s t h a t can be d e f i n e d or d e s c r i b e d i n terms of the c h i l d ' s a c t u a l behavior. Along with these b e h a v i o r s the parents should be asked to d e s c r i b e approximately how o f t e n they occur, where they occur, under what circumstances they occur, and f i n a l l y , the consequences o f these b e h a v i o r s . A f t e r t h i s has been completed the parents are asked to put t h e i r l i s t s t o gether and t r y to a r r i v e at what they f e e l are the two most n e g a t i v e behaviors their c h i l d e x h i b i t s as w e l l as the two most p o s i t i v e behaviors he or she e x h i b i t s . T h i s l a s t p a r t of the i n t a k e i n t e r v i e w g i v e s the t h e r a p i s t important i n s i g h t s i n t o how the parents communicate together and how each o f them ' p i c t u r e s ' t h e i r c h i l d . The t h e r a p i s t should be somewhat p a s s i v e and a c t l i k e a moderator f o r the e a r l y p a r t when the parents are comparing t h e i r l i s t s . For example, the t h e r a p i s t might f i n d t h a t o n l y one parent sees the c h i l d as having any problems while the o t h e r i s very pro-t e c t i v e of the c h i l d . T h i s e x e r c i s e , b e s i d e s p r o v i d i n g very v a l u a b l e i n f o r m a t i o n , w i l l a l s o g i v e the t h e r a p i s t some i d e a as to how w e l l the parents can cooperate together on a task. The t h e r a p i s t , i f needed, should e v e n t u a l l y promote t h i s co- . 48 o p e r a t i o n between the two parents and have them at the end of t h i s i n t e r v i e w e x p e r i e n c i n g what i t i s l i k e to work tog e t h e r i n h e l p i n g to s o l v e t h e i r c h i l d ' s problems r a t h e r than f i g h t i n g w i t h each o t h e r . F i n a l l y , and j u s t as i m p o r t a n t l y , t h i s e x e r c i s e has the parents take the f i r s t steps i n the o r g a n i z a t i o n o f what had probably p r e v i o u s l y been a very d i s o r g a n i z e d household. For example, the parents are s t a r t i n g to t h i n k about some of the good t h i n g s t h a t their c h i l d does and not o n l y the bad t h i n g s . The parents are being drawn i n t o the treatment o f the c h i l d by themselves wi t h the t h e r a p i s t ' s help and guidance. During the i n t a k e i n t e r v i e w the t h e r a p i s t uses Rogerian s k i l l s i n h e l p i n g the parents e x p l a i n t h e i r d i f f i c u l t i e s w i t h t h i s c h i l d . The t h e r a p i s t i s empathic towards the parents f o r the t r o u b l e they say they have had to put up w i t h and r e i n f o r c e s through h i s or her t h e r a p e u t i c s k i l l s the parents commitment towards h e l p i n g the c h i l d and i s as p o s i t i v e and upbeat as p o s s i b l e d u r i n g the e n t i r e i n t e r v i e w . When the parents l e a v e the i n t a k e i n t e r v i e w they should f e e l p o s i t i v e about themselves and o p t i m i s t i c about t h e i r problem. They w i l l have taken an a c t i v e p a r t i n the very i n i t i a l steps to h e l p t h e i r p a r t i c u l a r c h i l d . They should leave the t h e r a p i s t ' s o f f i c e f e e l i n g l i k e r e s p o n s i b l e p a r e n t s . , I t should be noted t h a t the i n t a k e i n t e r v i e w may s t r e t c h out over more than one i n t e r v i e w . There should be no s t r i c t time l i m i t i n terms of one o r tv/o i n t e r v i e w s to accomplish the tasks l i s t e d above. The t h e r a p i s t may f i n d the parents have 49 r a i s e d c e r t a i n i s s u e s t h a t are of a good deal o f concern t o them and t h a t h i s t i m e t a b l e may have to be more f l e x i b l e . A. 3 . B a s e l i n e B a s e l i n e i s the l a s t component to come under the broad heading o f Assessment. The term b a s e l i n e r e f e r s to the acc u r a t e documentation by e i t h e r the parents or the t h e r a p i s t o f the c u r r e n t s p e c i f i e d b e h a v i o r s o f the t a r g e t e d c h i l d . The c o l l e c -t e d b a s e l i n e data w i l l serve as a r e c o r d of the c h i l d ' s behav-i o r b efore any form of treatment i s implemented. With the c o l -l e c t i o n of accurate b a s e l i n e data the t h e r a p i s t and the parents can a c t u a l l y see whether there has been any p o s i t i v e and con-c r e t e b e h a v i o r a l change i n the problem behaviors o f the c h i l d . T h e r e f o r e , the b a s e l i n e component o f the proposed model i s i n -t e r g r a l l y t i e d to the f i f t h component c a l l e d Assessment o f Change. There are e s s e n t i a l l y two v a l i d methods o f c o l l e c t i n g b a s e l i n e i n f o r m a t i o n ; a) home o b s e r v a t i o n s by the t h e r a p i s t , and b) home o b s e r v a t i o n s by the parents. T h i s i n v e s t i g a t i o n w i l l o n l y cover the l a t t e r method. For i n f o r m a t i o n concerning home o b s e r v a t i o n s by a t h e r a p i s t the reader should r e f e r to Reid (1978). B a s e l i n e Data C o l l e c t i o n by the Parents The c o l l e c t i o n o f the b a s e l i n e data by the parents can sometimes i n d i c a t e to the t h e r a p i s t j u s t how devoted the parents are to the treatment program. During the b a s e l i n e p e r i o d the parents are asked to c o l l e c t data on the fou r behaviors they s p e c i f i e d i n the in t a k e i n t e r v i e w . Gelfand and Hartman (1968) 50 suggest t h a t o b s e r v a t i o n o f problem behavior frequency should a l s o be accompanied by b a s e l i n e o b s e r v a t i o n of p r o s o c i a l behav-i o r s . T h i s i s not an easy task f o r the parents to do. The parents have many o t h e r t h i n g s to do i n t h e i r day-to-day l i v e s and have brought the c h i l d to the t h e r a p i s t f o r h e l p . As I p o i n t e d out e a r l i e r , the blu e c o l l a r parent o f t e n expects d i r e c -t i o n and a u t h o r i t y from the t h e r a p i s t . However, the t h e r a p i s t must be e s p e c i a l l y s e n s i t i v e to the unexpected work l o a d he i s p u t t i n g on the parents i n the very e a r l y stages o f the treatment. The p a r e n t s , u s u a l l y , would l i k e to cooperate as much as p o s s i -b l e but i t i s the t h e r a p i s t who i s i n charge and i t i s he or she who should do most of the work. T h e . t h e r a p i s t , t h e r e f o r e , must be aware of the seemingly l a r g e amount o f work t h a t he expects the parents to t a c k l e t h a t has no apparent immediate p a y - o f f s f o r them. With the above c a u t i o n s i n mind i t i s now appropriate for the t h e r a p i s t ' s second, o r perhaps t h i r d , i n t e r v i e w w i t h the p a r e n t s . The f i r s t t h i n g t h a t he or she must teach the parents i s how to observe o r a t t e n d to the t a r g e t e d c h i l d ' s behaviors ( P a t t e r s o n , 19 71). One approach to t h i s task i s f o r the t h e r a p i s t to r o l e -p l a y one of the f o u r t a r g e t e d behaviors and i n s t r u c t the parents j u s t how to r e c o r d t h e i r b a s e l i n e data. The t h e r a p i s t ' s r o l e -p l a y should be t r i e d by each parent f o r each behavior so as to make q u i t e c e r t a i n to them j u s t what behaviors they w i l l be l o o k i n g f o r . The a c t i v e involvement of the parents d u r i n g t h i s i n t e r v i e w f u r t h e r h e lps them to f e e l a p a r t of the therapy. 51 Once the t h e r a p i s t i s s a t i s f i e d t h a t the parents w i l l be able to r e c o r d the b a s e l i n e data f o r the t a r g e t e d behaviors he arranges, i n c o o p e r a t i o n with the parents, a schedule o f obser-v a t i o n and phone c a l l s i s developed. The schedule of observa-t i o n u s u a l l y i n v o l v e s both parents having to observe the t a r g e t e d c h i l d f o r one hour each day d u r i n g which the two n e g a t i v e be-h a v i o r s are most l i k e l y to occur. For example, the f a t h e r , due to h i s work, may be a b l e to observe o n l y i n the morning or a f t e r n o o n . With blue c o l l a r parents there i s more than a good chance t h a t both parents w i l l be working s h i f t work. A c a r e f u l r e c o r d i s kept by both parents o f the number o f times each t a r g e t e d behavior has o c c u r r e d . The f o l l o w i n g day one o f the parents phones the c l i n i c o r the t h e r a p i s t ' s o f f i c e w ith the i n f o r m a t i o n which they have c o l l e c t e d . The t h e r a p i s t then records t h i s i n f o r m a t i o n on a master t a l l y sheet f o r f u t u r e r e f e r e n c e . The phone c a l l s are made at a f l e x i b l e but pre-arranged time. For example, the mother might phone the t h e r a p i s t every morning f o r one week at'10:A.M. The e f f e c t i v e use o f the t h e r a p e u t i c techniques of empathy, genuiness and u n c o n d i t i o n a l p o s i t i v e r e g a r d p l a y a major r o l e i n r e l a t i o n to the parent's phone c a l l s to the t h e r a p i s t . 'Base-l i n e ' i s a time when the parents are i n v o l v e d i n a process t h a t i s r e l a t i v e l y new to them where they are c o l l e c t i n g data and p o s s i b l y do not r e a l l y understand i t s p l a c e i n the treatment of t h e i r c h i l d ' s problem. The t h e r a p i s t must be very s e n s i t i v e i n the manner i n which he t a l k s to the mother or f a t h e r when they c a l l with t h e i r c o l l e c t e d i n f o r m a t i o n . For example, the t h e r a p i s t might f i n d h i m s e l f or h e r s e l f having to d e a l w i t h a complaining parent who w i l l o n l y complain about the t e r r i b l e b e h a v i o r o f t h e i r c h i l d and not get to the o b s e r v a t i o n i n f o r m a t i o n t h a t they have o r have not c o l l e c t e d . The r u l e i s data f i r s t . The parent upon phoning must f i r s t o f a l l g i ve the t h e r a p i s t t h e i r o b s e r v a t i o n s from the day b e f o r e . A f t e r the i n f o r m a t i o n has been recorded then the t h e r a p i s t should use h i s t h e r a p e u t i c s k i l l s to empathize and comfort the f r u s t r a t e d and confused parent. The t h e r a p i s t should c o n t i n -uously r e i n f o r c e and encourage the parent f o r h i s o r her e f f o r t s a t home and assure them t h a t t h i s b a s e l i n e p e r i o d i s an impor-t a n t p a r t of the o v e r a l l treatment p l a n . An example of p a r t of such a c o n v e r s a t i o n might be; T h e r a p i s t : Mrs. Smith, you are r e a l l y doing such a good job o f phoning me r e g u l a r l y w i t h your i n f o r m a t i o n about Tom. I know i t must be t e r r i b l y hard f o r you to manage him as w e l l as take care o f your house and do a l l those household chores. I know I would sure have a hard time and f i n d i t very f r u s t r a t i n g . There are o n l y a few more days l e f t where you w i l l have to do t h i s and then we can r e a l l y s i t down and come up w i t h some ways o f r e a l l y g e t t i n g r i d of Tom's bad b e h a v i o r s . Thank-you f o r c a l l i n g . I ' l l t a l k to you again tomorrow. During the c o l l e c t i o n of b a s e l i n e data by the parents the parents are u s u a l l y spending an u n u s u a l l y l a r g e amount of time o b s e r v i n g the t a r g e t e d c h i l d . Remember, i f the parents are f o l l o w i n g the t h e r a p i s t ' s i n s t r u c t i o n s they are each c l o s e l y , but not too o b v i o u s l y , o b s e r v i n g the c h i l d f o r one hour each day f o r one week. For blue c o l l a r p a r e n t s , who are u s u a l l y both working f u l l e i g h t -hour s h i f t s and then f u l f i l l i n g o t h e r o b l i g a -t i o n s , t h i s i s an e x t r a o r d i n a r y amount of time f o r o b s e r v a t i o n . One e f f e c t t h i s can have on the c h i l d i s an o v e r a l l b ehavior improvement d u r i n g the b a s e l i n e p e r i o d , even b e f o r e o f f i c i a l treatment i n t e r v e n t i o n . As Tharp and Wetzel (19 69) note, 'One of the most powerful d e v e l o p i n g r e i n f o r c e r s i s a t t e n t i o n from both a d u l t s and peers' (p. 20). Improvement w i l l most l i k e l y be noted i n the c h i l d ' s over-a l l a t t i t u d e and behavior and not n e c e s s a r i l y the behaviors the parents t a r g e t e d . Many c h i l d r e n misbehave as ah onl y . means of a t t r a c t i n g t h e i r parent's a t t e n t i o n . With the parents making s p e c i a l note o f t h e i r p o s i t i v e as w e l l as ne g a t i v e be-h a v i o r s the c h i l d r e n may a c t out l e s s f r e q u e n t l y . The t h e r a -p i s t has i n s t r u c t e d them o n l y to observe and note the beh a v i o r i n i t s frequency and d e s c r i p t i o n and take minimal a c t i o n i n stop p i n g i t . T h i s i s , o f course, extremely hard f o r the parents to do e s p e c i a l l y i f the c h i l d i s screaming a t the top of h i s or her v o i c e . Here again, the t h e r a p i s t must be e s p e c i a l l y s e n s i -t i v e to the parent when he or she i s t a l k i n g to them on the phone. In the next s e c t i o n the above d e s c r i p t i o n of p a r e n t a l a t t e n t i o n or n o n - a t t e n t i o n i s very c l o s e to an a c t u a l i n t e r -v e n t i o n s t r a t e g y and w i l l be d i s c u s s e d l a t e r i n the treatment model. B. Treatment B.1. Parent T r a i n i n g Sessions With an accurate r e c o r d o f the t a r g e t e d c h i l d ' s b ehavior over a one week p e r i o d i t i s time f o r the t h e r a p i s t and the parents to move onto the next p h a s e - treatment. Here, the t h e r a p i s t i n v o l v e s the parents i n e d u c a t i o n a l s e s s i o n s on how 54 to e f f e c t i v e l y cope w i t h t h e i r c h i l d . The s e s s i o n s u s u a l l y i n -v o l v e o t h e r parents t h a t the t h e r a p i s t i s working w i t h . By i n v o l v i n g d i f f e r e n t parents i n these meetings the t h e r a p i s t p r o v i d e s h i s or her c l i e n t s with an ongoing support group. That i s , the parents come to r e a l i z e t h a t they are not alone w i t h t h e i r problems i n d e a l i n g with t h e i r c h i l d r e n and t h a t o t h e r parents a l s o have s i m i l a r or even very d i f f e r e n t problems from t h e i r own. The next s e c t i o n w i l l look at two b e h a v i o r a l avenues.of t r a i n i n g parents t o become b e t t e r a t d e a l i n g w i t h t h e i r c h i l d -ren's b e h a v i o r . They are; a) S o c i a l P r a i s e Contingency T r a i n -i n g , and b) P o i n t o r Token-Incentive C o n t r a c t i n g . However, be-f o r e d i s c u s s i n g the d e t a i l s o f these two techniques The T r i a d i c Model (Tharp and Wetzel, 1969) w i l l be i n t r o d u c e d and e x p l a i n e d . The T r i a d i c Model The t r i a d i c model evolves q u i t e n a t u r a l l y from the approach o f some o f today's behavior t h e r a p i s t s . I n c r e a s i n g l y , behavior t h e r a p i s t s have d i s c o v e r e d t h a t there i s l i t t l e need f o r d i r e c t c o n t a c t w i t h the c l i e n t . Reinforcement theory has shown them t h a t d i r e c t c o n t a c t with the c h i l d should n a t u r a l l y go to the person(s) who; a) possess the c h i l d ' s r e i n f o r c e r s , and b) are a b l e to p l a c e them on contingency (Tharp and Wetzel, 1969). In most cases the t h e r a p i s t i s not t h a t person. T h e r e f o r e , what develops i s not the t r a d i t i o n a l t h e r a p e u t i c dyad of the medical model, wi t h j u s t the doctor and the p a t i e n t but r a t h e r a t r i a d . The t r i a d c o n s i s t s o f : 1) The t h e r a p i s t , who a c t s as a c o n s u l t a n t to the mediator. 2) A mediator, who c o u l d be f o r example, a parent or a teacher. 3) A t a r g e t , who i s the c l i e n t o r i n the p r e s e n t example i s c h i l d i d e n t i f i e d as the problem by the parent. Tharp and Wetzel (1969) sees the c o n s u l t a n t as being anyone who possesses knowledge s p e c i f i c to the problem, the mediator as anyone who possesses the r e q u i r e d r e i n f o r c e r s and who can dispense them c o n t i n g e n t l y , and the t a r g e t as any person with a F i g . 1. The T r i a d i c Model L i k e the hub of a two-pronged wheel, the mediator f u n c t i o n s i n a p o s i t i o n t h a t i s c r u c i a l to the success of the o v e r a l l i n t e r v e n t i o n s t r a t e g y . The mediator, i s i n c o n t a c t with the c o n s u l t a n t - t h e r a p i s t who i n s t r u c t s and guides h i s or her a c t i o n s w i t h r e s p e c t to the t a r g e t . The mediator i s the i n t e r m e d i a r y o f the c o n s u l t a n t . For the purposes of the p r e s e n t i n v e s t i g a t i g a -t i o n i t w i l l be assumed t h a t the parent(s) i s " t h e mediator and po-ssesses the two c r i t e r i a necessary to f u n c t i o n as a mediator i n the t r i a d i c model. 56 The importance of the parent i n the t r i a d i c model cannot be o v e r s t a t e d . Because the contingency management technique a c t s as the foundation f o r the t h e r a p i s t ' s i n t e r v e n t i o n s t r a t -egy the r o l e o f the parent i s c r u c i a l . In o r d e r to rearrange c e r t a i n c o n t i n g e n c i e s so t h a t f a v o r a b l e behavior i s rewarded and u n f a v o r a b l e behavior i s not rewarded the t h e r a p i s t must be sure t h a t the parents can a c t c o n t i n g e n t l y upon the c h i l d ' s behavior. With the parent p l a y i n g such a c r i t i c a l r o l e i n the t r i a d i c treatment s t r a t e g y i t becomes apparent t h a t the q u a l i t y and c o n s i s t e n c y of h i s or her behavior i s of the utmost importance. Tharp and Wetzel (1969) note: . . . i t becomes apparent t h a t the c e n t r a l i s s u e must become the maintenance of the mediator's d e s i r e d behavior. Since the key agent f o r c o n t r o l i s the mediator, the t a r g e t ' s behavior i s a n e a r - s t r i c t f u n c t i o n of the e f f e c t i v e n e s s of the mediator. T h e r e f o r e , b e h a v i o r m o d i f i c a t i o n i n the n a t u r a l environment stands o r f a l l s on the e f f e c t i v e n e s s of the b e h a v i o r o f the mediator (p. 51). The e f f e c t i v e n e s s o f the parent's behavior depends upon the r e -inforcement he or she r e c e i v e s f o r t h e i r performance w i t h the. c h i l d . The r e i n f o r c ement f o r the parent can come from as many as three d i f f e r e n t sources a t once. The reinforcement can come from; a) the t h e r a p i s t , b) the t a r g e t ( c h i l d ) , and/or c) from o t h e r s i n the c h i l d ' s environment. Reinforcement from the t h e r a p i s t i s the most important source of encouragement and support f o r the parent (Tharp and Wetzel, 1969). Since the c h i l d ' s b ehavior m o d i f i c a t i o n i s c o r r e l a t e d w i t h e f f e c t i v e n e s s o f the parents, the t h e r a p i s t i s c o n s t a n t l y r e i n f o r c i n g the parent's work whether i t be by phone c a l l s , home v i s i t s , o r moral support. The t h e r a p i s t uses the same p r i n c i p l e s o f l e a r n i n g theory w i t h the parents as the parents are with t h e i r c h i l d . Furthermore, the t h e r a p i s t ' s use o f h i s o r her humanistic s k i l l s when t a l k i n g w i t h the parents cannot be emphasized enough. A second source o f reinforcement f o r the parents i s the c h i l d . As the parent's attempts a t behavior m o d i f i c a t i o n im-prove they w i l l be r e i n f o r c e d by the improvements i n t h e i r c h i l d ' s behavior. From my experience, I have noted t h a t even the very s m a l l e s t improvements i n the c h i l d ' s b ehavior, im-provements t h a t cannot be n o t i c e d by the t h e r a p i s t o r o t h e r s , are u s u a l l y n o t i c e d immediately by the parents and have accom-panying r e i n f o r c i n g consequences. . The t h i r d source o f rei n f o r c e m e n t f o r the parents i s the reinforcement from 'others' (Tharp and Wetzel, 1969). Others can r e f e r to anyone i n the c h i l d ' s n a t u r a l environment w i t h whom the c h i l d has c o n t a c t . With the gradual improvements i n the c h i l d ' s behavior these o t h e r people, who can be s c h o o l p e r s o n n e l , peers o r oth e r parents who know the c h i l d , n a t u r a l l y comment to the parent on how much t h e i r c h i l d has improved and what a good job they, the pare n t s , have been doing. S o c i a l P r a i s e Contingency T r a i n i n g In r e c e n t r e s e a r c h , Gordon (19 71) r e p o r t e d t h a t as many as nine out o f ten parents communicate wi t h t h e i r c h i l d r e n i n a manner t h a t i s ' d e s t r u c t i v e to both the k i d s and the r e l a t i o n -s h i p ' (p. 1). From a reinforcement theory p e r s p e c t i v e the communication t h a t Gordon r e f e r s to has no c o n s i s t e n c y to i t 58 and f o l l o w s few, i f any, of the r u l e s o f l e a r n i n g theory. Parents w i l l sometimes v e r b a l l y r e i n f o r c e a c h i l d ' s b ehavior w h i l e a t o t h e r times punish t h a t same behavior. Even worse, parents w i l l r a r e l y r e i n f o r c e o r p r a i s e p o s i t i v e behavior o f the c h i l d and onl y punish o r v e r b a l l y abuse the c h i l d ' s nega-t i v e b e havior. Furthermore, not onl y must some parents be made to r e a l i z e t h a t t h e i r s o c i a l r einforcement i n the form of v e r b a l communication i s important, but they a l s o should r e a l i z e the important p o s i t i o n t h e i r behavior o c c u p i e s as f a r as i t being a model f o r t h e i r c h i l d r e n . F r i e s e n and Csapo (1975) note: F a m i l i a r i t y w i t h the a p p l i c a t i o n of the b a s i c r u l e s of l e a r n i n g , e f f e c t s o f s o c i a l i n t e r a c t i o n might prevent the a c q u i s i t i o n and maintenance of a g r e a t v a r i e t y of maladaptive c h i l d b ehaviors (p. 80). I t i s the b a s i c r u l e s o f l e a r n i n g and the understanding o f these by the parents t h a t the presen t s e c t i o n w i l l i n v e s t i g a t e . A b a s i c p r i n c i p l e o f operant l e a r n i n g theory i s t h a t be-haviors^ when they are r e i n f o r c e d / w i l l i n c r e a s e and behaviors when they are i g n o r e d o r punished w i l l decrease. I t i s t h i s one b a s i c p r i n c i p l e t h a t the t h e r a p i s t must teach the parents i n order f o r them to take t h e i r f i r s t few steps towards becoming more e f f e c t i v e p a r e n t s . Some t h e r a p i s t s , such as P a t t e r s o n (1975), a s s i g n the parents a book to read. The book c o n t a i n s i n f o r m a t i o n on reinforcement theory w i t h i l l u s t r a t i o n s and a f i l l - i n - t h e - b l a n k format. The book i s very s h o r t and simply worded so t h a t as l i t t l e d i f f i c u l t y as p o s s i b l e i s encountered by the parents i n read i n g i t . The parents are t o l d they w i l l be given a s h o r t q u i z when they are f i n i s h e d the book and t h a t treatment w i l l not begin u n t i l they have both f i n i s h e d the book. Delays or d i f f i c u l t i e s here can sometimes be handled by use o f the parent's breakage f e e . The books a s s i g n e d are u s u a l l y F a m i l i e s , A p p l i c a t i o n s of S o c i a l L e a r n i n g to Family  L i f e by P a t t e r s o n (19 71) or L i v i n g w i t h C h i l d r e n by P a t t e r s o n and G u l l i o n (1968). The l a t t e r book i s recommended f o r f a m i l -i e s w i t h a l i m i t e d vocabulary or r e a d i n g l e v e l such as the blue c o l l a r f a m i l y . Some r e s e a r c h e r s ( O ' D e l l , F l y n n , and B e n l o l o , 1977) have r e c e n t l y d i s c o v e r e d t h a t l e n g t h l y t r a i n i n g of parents i n the general p r i n c i p l e s and theory of behavior m o d i f i c a t i o n did: not b e t t e r prepare them to deal w i t h a problem more adequately than groups of parents w i t h very l i t t l e g e neral knowledge o f behav-i o r m o d i f i c a t i o n . However, the d i f f e r e n c e s t h a t d i d occur between the v a r i o u s groups i n d i c a t e d t h a t some g e n e r a l knowledge o f the p r i n c i p l e s o f b e h a v i o r m o d i f i c a t i o n were h e l p f u l f o r parents who a p p l i e d t h i s knowledge d i r e c t l y i n the home. O v e r a l l , the f i n d i n g s tended to i n d i c a t e a b r i e f e r t r a i n i n g p e r i o d f o r the p a r e n t s . Another approach to educating the parents on the c o n t i n g e n t use of s o c i a l p r a i s e i s by u s i n g the group meetings o f the par-ents. The t h e r a p i s t can r o l e - p l a y c e r t a i n procedures and there i s a l s o a s h o r t f i l m on s o c i a l r einforcement a v a i l a b l e f o r the parents to watch and d i s c u s s a f t e r i t i s over. The author p r e -f e r s the d i s c u s s i o n , r o l e - p l a y , and f i l m approach to a r e a d i n g assignment f o r the blue c o l l a r parent. By t h i s p o i n t i n the treatment, which can be three weeks f o l l o w i n g i n i t i a l t h e r a p i s t 6 0 c o n t a c t , t h e p a r e n t s u s u a l l y w a n t t o s e e s o m e r e s u l t s a n d w a n t s o m e c o n c r e t e s u g g e s t i o n s a s t o w h a t t h e y c a n d o t o b e b e t t e r a b l e t o c o p e w i t h t h e t a r g e t e d c h i l d . F u r t h e r m o r e , a n e d u c a -t i o n a l a p p r o a c h i n s u c h a n e n v i r o n m e n t u s i n g r o l e - p l a y i n g , m o d e l l i n g , a n d b e h a v i o r a l r e h e a r s a l u t i l i z e s s o m e o f t h e e a r l i e r s u g g e s t i o n s f o r a . s t y l e a o f . t r e a t m e n t f o r t h e b l u e c o l l a r f a m i l y . W h a t f o r m t h e s e g r o u p s e s s i o n s t a k e d e p e n d s u p o n t h e i n d i -v i d u a l g r o u p c o m p o s i t i o n . H o w e v e r , i n g e n e r a l a p a r e n t g r o u p s e s s i o n t a k e s o n c e r t a i n q u a l i t i e s a n d h a s a b a s i c s t r u c t u r e t o i t . T h e t h e r a p i s t m u s t k e e p i n m i n d t h r o u g h o u t t h e s e e a r l y m e e t i n g s w i t h t h e p a r e n t s t h a t h e o r s h e i s t e a c h i n g o r t r a i n i n g t h e p a r e n t s t o t a k e a p o s i t i v e a p p r o a c h t o w a r d s h a n d l i n g t h i s c h i l d . F o r y e a r s t h e p a r e n t s h a v e p o s s i b l y h a d o n l y a n e g a t i v e a n d p u n i t i v e a p p r o a c h t o w a r d s t h i s c h i l d a n d n o w t h e y m u s t l e a r n t o b e h a v e d i f f e r e n t l y . F u r t h e r m o r e , t h e t h e r a p i s t m u s t b e s e n -s i t i v e t o t h e p o s s i b i l i t y t h a t t h e c h i l d ' s b a d b e h a v i o r s h a v e a l l i e n a t e d t h e p a r e n t s f r o m h i m o r h e r . T h e t h e r a p i s t ' s f i r s t j o b i s t o i n s t r u c t t h e p a r e n t s i n a f e w o f t h e m o r e b a s i c r u l e s o f r e i n f o r c e m e n t t h e o r y . A s t h e a r c h i t e c t o f c h a n g e , t h e t h e r a p i s t m u s t s u p p l y h i s b u i l d e r s w i t h t h e n e c e s s a r y m a t e r i a l s a n d t o o l s w i t h w h i c h t h e y c a n w o r k . P e r h a p s o n e o f t h e b e s t a p p r o a c h e s t o t h i s d i d a c t i c b e g i n n i n g i s f o r t h e t h e r a p i s t t o e m p l o y a s m u c h d e m o n s t r a t i o n a n d s e l f -d i s c l o s u r e a s p o s s i b l e . H u m o r i s a g o o d t o o l w i t h w h i c h t h e s e l a t t e r t w o t e c h n i q u e s c a n b e r e i n f o r c e d t o e f f e c t i v e l y c o m m u n i -c a t e t o t h e b l u e c o l l a r p a r e n t s t h e f r a m e w o r k o f o p e r a n t l e a r n -i n g t h e o r y . F i n a l l y , o n c e t h e t h e r a p i s t t h i n k s t h a t m o s t o f t h e parents have a grasp o f the m a t e r i a l , he i n v o l v e s the whole group i n l i v e l y games or r o l e - p l a y i n g s i t u a t i o n s i n which they can use what they have l e a r n e d . Reinforcement c o n s i s t e n c y i s s t r e s s e d throughout. The parents reinforcement vocabulary can be added to by the t h e r a p i s t m o d e l l i n g many d i f f e r e n t phrases and words and non-verbal g e s t u r e s . Sometimes parents simply do not know what words to use. The t h e r a p i s t must be c a r e f u l i n h i s suggestions so t h a t they are words and phrases t h a t would n a t u r a l l y come from the same value and b e l i e f system as the mediator's. Reinforcement of the c h i l d i n terms of s o c i a l p r a i s e and r e c o g n i t i o n f o r h i s or her p o s i t i v e behaviors w i l l not guarantee the e l i m i n a t i o n o f any or a l l o f h i s negative or t a r g e t e d behav-i o r s . The reinforcement strengthens the c o n s i s t e n c y and q u a l i t y of the p o s i t i v e b e h a v i o r s o f the c h i l d . The c h i l d l e a r n s t h a t he can get p a r e n t a l a t t e n t i o n by doing p o s i t i v e t h i n g s . When the c h i l d behaves i n a n e g a t i v e f a s h i o n the parent i s i n s t r u c t e d to ignore the behavior. However, there are two i n s t a n c e s when j u s t simply i g n o r i n g a c h i l d ' s n e g a t i v e i s not enough and a form o f punishment from the parents i s necessary. They a r e : a) d i s o b e y i n g a d i r e c t command or i n s t r u c t i o n from the parent, and b) damaging o r h u r t i n g o t h e r people or p r o p e r t y (Fleischman and Conger, 1978). The form t h a t t h i s punishment takes i s ex-p l a i n e d to the c h i l d a t the very beginning o f treatment by the  par e n t s . I t i s e x p l a i n e d to the c h i l d under what circumstances i t w i l l occur and what the c h i l d i s expected to do. T h e r e f o r e , any misbehavior o r diso b e d i e n c e by the c h i l d i s met wit h a con-sequence t h a t i s f a m i l i a r to the c h i l d . Time-Out. Fleischman and Conger (1978) d e s c r i b e time-out i n the f o l l o w i n g manner; The purpose o f time-out i s to separate the c h i l d immediately from a s i t u a t i o n t h a t i n some way r e i n f o r c e s h i s . i n a p p r o p r i a t e behavior. I t i s the immediacy and s e p a r a t i o n t h a t makes time-out e f f e c -t i v e . Time-out does not need to be done i n a h o s t i l e , angry o r p u n i t i v e manner. The b e s t procedure i s a m a t t e r - o f - f a c t and calm a t t i t u d e (p. 184). Time-out f o l l o w s a r o u t i n e - l i k e procedure. F i r s t , the c h i l d i s asked t o stop h i s o r her misbehavior. I f the c h i l d continues the parent i n s t r u c t s the c h i l d t h a t they have disobeyed and are to go to time-out. No t h r e a t s are to be used, the c h i l d i s not to be argued with or l i s t e n e d t o . The c h i l d then immedi-a t e l y goes to a pre-determined area o f the house where he o r she w i l l be s o c i a l l y i s o l a t e d from those around him. For exam-p l e , a s m a l l room with any toys and books removed c o u l d be s e t -up. The c h i l d i s to stay i n time-out f o r anywhere from f i v e minutes to t h i r t y minutes. At the end of the 'time-out' the parent simply i n s t r u c t s the c h i l d t h a t time-out' i s over and r e t u r n s to whatever they were doing. F u r t h e r disobedience by the c h i l d puts him o r her back i n t o time-out' with e x t r a time added on. P o i n t or Token-Incentive C o n t r a c t i n g The parent group s e s s i o n s can take from three to f o u r weeks with a group meeting once a week and an i n d i v i d u a l meeting w i t h the t h e r a p i s t once a week. At the p r i v a t e meeting w i t h the t h e r a p i s t the parents can share t h e i r more p r i v a t e complaints or f a i l u r e s w i t h the t h e r a p i s t . Sometimes the t h e r a p i s t w i l l f i n d t h a t s o c i a l p r a i s e contingency t r a i n i n g i s not enough and t h a t One or both of the parents need a s t r o n g e r method f o r them to begin to d e a l e f f e c t i v e l y with t h e i r c h i l d r e n . A t t h i s p o i n t the t h e r a p i s t may, a f t e r o n l y one or two group meetings, decide to i n t r o d u c e P o i n t or Token-Incentive C o n t r a c t i n g . C o n t r a c t i n g i s based on e a r l i e r work done by P a t t e r s o n (1971), (1975), and S t u a r t (1971). The use of a 'Contract' to deal w i t h the c h i l d ' s two o r i g i n a l p r e s e n t i n g problems i s what p o i n t or token c o n t r a c t i n g i s about. C o n t r a c t i n g i s not done i n a group wi t h o t h e r parents and f o r c o n t r a c t i n g to begin the t h e r a p i s t alone meets with the two parents and t h e i r t a r g e t e d c h i l d . F i r s t , i t must be understood what a c o n t r a c t i s . A c o n t r a c t i s a document drawn up by the p a r e n t s , the c h i l d and the t h e r a -p i s t . An example o f a c o n t r a c t can be found i n P a t t e r s o n (1975), Appendix I or Fleischman and Conger (1978). A ' c o n t r a c t ' i s a w r i t t e n document d e t a i l i n g the s p e c i f i c behaviors and r e i n f o r c i n g arrangements to which two o r more f a m i l y members have agreed. Because they are w r i t t e n , there i s l e s s chance f o r c o n f u s i o n . A c o n t r a c t r e q u i r e s d a i l y a t t e n t i o n and repeated e n t r i e s , i t f u n c t i o n s as a k i n d o f c o n s i s t e n t p r o s t h e t i c device s u p p o r t i n g the program (Patt e r s o n , 1975, pps. 63-64). With the c o n t r a c t the c h i l d l e a r n s t h a t by doing c e r t a i n behav-i o r s he w i l l g ain p o i n t s which can earn him or her c e r t a i n p r i -veleges. The t h e r a p i s t ' s next move i s to help the parents and the c h i l d b e h a v i o r a l l y j d e f i n e the two p o s i t i v e and two n e g a t i v e behaviors which w i l l appear on the c o n t r a c t . These can be w r i t t e n down on the back of the c o n t r a c t o r on a separate sheet of paper and a t t a c h e d to the c o n t r a c t . Next, the t h e r a p i s t s e t s a l i m i t of 10 p o i n t s o r tokens t h a t can be earned per day f o r 64 each s p e c i f i e d behavior cumulatively (Patterson, 1975) . The behaviors have points assigned to them which the c h i l d can accumulate during the course of the day for a maximum score of 10 points. The points or tokens must be awarded immediately upon doing or not doing one of the behaviors. At the end of the day the c h i l d may 'cash' i n his points or tokens for an agreed upon p r i v i l e g e . An example of such a contract appears below; 1) Behaviors a) ta l k i n g q u i e t l y to my s i s t e r i n the morning; no y e l l i n g , - 4 points b) putting away my clothes and making my bed, - 3 points c) helping mom do the dishes, - 2 points d) doing 1/2 hour of homework a night, Sun. - Mon., - 2 points 2) P r i v i l e g e s (Patterson, 1975, p. 64) 10 points - stay up u n t i l 9:00 P.M. and watch t e l e v i s i o n 8 points - go to bed 8:30, get special dessert 6 points - go to bed 8:30 4 points - go to bed 7:30 2 points - go to bed 7:00 Minus or 0 points - wash dishes (alone) and go to bed 7:00 The contract's a c t i v i t i e s and point system operate on a dai l y basis. The c h i l d receives three types of pay-offs with th i s contract. F i r s t , the parent, upon seeing that the c h i l d has f u l f i l l e d one of the 4 behaviors, immediately praises the c h i l d s o c i a l l y . Some examples might include: 1) . " S e a n , t h a t was r e a l l y g r e a t t h e way y o u d i d n ' t y e l l a t y o u r s i s t e r a l l m o r n i n g . Y o u m u s t f e e l g o o d a b o u t y o u r -s e l f . 2) " T h a n k s S e a n f o r h e l p i n g me w i t h t h e d i s h e s . I t s u r e i s much e a s i e r f o r me t o g e t t h r o u g h t h e d a y when y o u h e l p me w i t h t h e d i s h e s . " S e c o n d l y , a t t h e same t i m e as t h e p a r e n t i s p r a i s i n g t h e c h i l d f o r h i s o r h e r p o s i t i v e b e h a v i o r t h e c h i l d i s a w a r d e d p o i n t s o r g i v e n t h e a p p r o p r i a t e n u m b e r o f t o k e n s . The p o i n t s a r e a d d e d t o a t a l l y s h e e t w h i c h i s p l a c e d somewhere w h e r e e v e r y b o d y i n t h e f a m i l y c a n s e e i t . I f p l a s t i c t o k e n s a r e p r e f e r r e d o v e r p o i n t s t h e n a t a l l y s h e e t i s s t i l l u s e d a n d t h e c h i l d c a n s t o r e h i s o r h e r t o k e n s i n , f o r e x a m p l e , a s m a l l b o x i n h i s / h e r r o o m . T h i r d l y , when t h e d a y i s o v e r t h e c h i l d ' c a s h e s ' i n t h e p o i n t s o r t o k e n s a c c o r d i n g t o t h e a g r e e d u p o n p r i v i l e g e s . When t h e c o n t r a c t h a s b e e n a g r e e d u p o n b y ; t h e p a r e n t s , t h e c h i l d , a n d t h e t h e r a p i s t , i t i s s i g n e d b y a l l t h r e e p a r t i e s a n d p o s t e d s o m e w h e r e w h e r e a l l c a n s e e i t , f o r e x a m p l e t h e r e f r i g e r -a t o r . T h i s p u b l i c p o s t i n g o f t h e c o n t r a c t a n d t h e t a l l y s h e e t i s a g o o d way t o g e t e v e r y o n e i n t h e h o u s e i n v o l v e d i n t h e t a r -g e t e d c h i l d ' s t r e a t m e n t . O t h e r s i b l i n g s a r e a s k e d t o comment d a i l y o n t h e i r b r o t h e r ' s o r s i s t e r ' s p r o g r e s s a s n o t e d b y t h e o n g o i n g r e c o r d o f t h e c o n t r a c t ' s t a l l y s h e e t . F a t h e r , when he a r r i v e s home f r o m w o r k , o r f o r t h a t m a t t e r m o t h e r , c a n i m m e d i a t e l y s e e how S e a n h a s b e h a v e d t h a t d a y a n d c a n p r a i s e h i m f o r b e h a v i o r s c o m p l e t e d . I t i s i m p o r t a n t h e r e f o r t h e t h e r a p i s t t o make t h e f a m i l y r e a l i z e t h a t o n l y t h e c h i l d ' s p r o g r e s s i s commented upon and the c h i l d i s not to be b u l l i e d , taunted, o r teased about the l a c k o f p o i n t s o r behaviors he or she has not done. The accent i s always on the p o s i t i v e . Secondly, the t a r g e t e d c h i l d i s to be commended f o r h i s behaviors on the con-t r a c t and not the number o f p o i n t s or tokens earned. Any c o n t r a c t can be r e - n e g o t i a t e d a t any time by the concerned p a r t i e s . The c h i l d ' s f i r s t few c o n t r a c t s should not be too demanding on him o r her. Some simple behaviors t h a t the c h i l d can a l r e a d y do wit h some r e g u l a r i t y might have to be added on with low p o i n t value a s s i g n e d to them so t h a t the c h i l d can s t a r t succeeding and moving i n a p o s i t i v e d i r e c t i o n immediately. The c h i l d should f e e l what i t i s l i k e t o succeed and achieve some p o i n t s as soon as the c o n t r a c t takes e f f e c t . G l a s s e r (1965) i s one t h e r a p i s t who f i r m l y b e l i e v e s t h a t a g r e a t e r focus on success i s needed f o r c h i l d r e n r a t h e r than a constant atmosphere of f a i l u r e , e s p e c i a l l y i n the e d u c a t i o n a l system. As the c h i l d begins a c h i e v i n g h i s f u l l l o a d o f p o i n t s q u i t e r e g u l a r l y the c o n t r a c t i s ad j u s t e d . For example, the c h i l d can work on another k i n d o f a c o n t r a c t where he or she accumulates p o i n t s o r tokens over the course of a week. At the end of the week the c h i l d can tu r n those p o i n t s i n t o c e r t a i n o t h e r agreed upon p r i v i l e g e s . These p r i v i l e g e s might i n c l u d e a movie, a smal l toy of h i s / h e r c h o i c e , o r a s p e c i a l request on the weekend d i n n e r menu. Behavior t h e r a p i s t s c a l l t h i s type o f b a r g a i n i n g o r con-t r a c t i n g with a c h i l d the e f f e c t i v e use of the Premack P r i n c i p l e (Premack, 1965) . The Premack P r i n c i p l e i s based on the premise t h a t a c t i v i t i e s the c h i l d enjoys may be used as e f f e c t i v e r e i n -f o r c e r s f o r l e s s p l e a s u r a b l e b e h a v i o r s . T h e r e f o r e , i n the case of 'Sean 1, the parents might have observed the enjoyment t h a t Sean gets by s t a y i n g up l a t e and watching t e l e v i s i o n o r e a t i n g sweet d e s s e r t s . On the other hand, Sean i s i n c o n s i s t e n t i n doing h i s homework, does not l i k e doing h i s chores or making h i s room t i d y , and o f t e n y e l l s at h i s s i s t e r i n the morning when they are g e t t i n g ready f o r s c h o o l . The pare n t s , who c o n t r o l the use of the t e l e v i s i o n and what i s f o r d i n n e r , c o n t i n g e n t l y use these to a c c e l e r a t e behaviors that Sean does not l i k e and reduce n e g a t i v e b e h a v i o r s . During the c o n t r a c t i n g p e r i o d , the t h e r a p i s t i s c o n s u l t i n g with the parents as to how t h i n g s are p r o g r e s s i n g . C o n s u l t a -t i o n by the t h e r a p i s t w i t h the parents i s by t h i s p o i n t i n treatment probably the major form o f c o n t a c t between the two p a r t i e s . C o n s u l t a t i o n i t s e l f i s becoming more and more impor-t a n t as a t o o l o f the t h e r a p i s t and some r e s e a r c h e r s say i t i s even becoming a t r e n d i n c o u n s e l l i n g (Cottingham, 1965; Gazda, 1965). Mayer (1972) sees the t h e r a p i s t ' s o v e r a l l o b j e c t i v e i n the c o n s u l t a t i o n process as h e l p i n g the parents to implement b e h a v i o r a l procedures. F r i e s e n (Note 1.) sees c o n s u l t a t i o n as, '...an e d u c a t i o n a l endeavour... to enhance the parent's know-ledge o f behavior dynamics, l e a d e r s h i p , and to p r o v i d e support f o r l e a r n i n g and a p p l y i n g p a r e n t i n g s k i l l s ' . I t i s my e x p e r i -ence t h a t i t i s the support and encouragement by the c o n s u l t a n t or the t h e r a p i s t t h a t i s c r u c i a l j u s t as the rei n f o r c e m e n t f o r the parent i s c r i t i c a l . Hammond, Hepworth and Smith (1977) 68 note: 'Encouragement i s v i t a l i n m a i n t a i n i n g the c l i e n t ' s hope, an i n d i s p e n s i b l e p r e r e q u i s i t e to change' (p. 54). The t h e r a p i s t i s i n d a i l y c o n t a c t , u s u a l l y by phone, wi t h the parents and r e i n f o r c e s the parent's e f f o r t s a t t h i s new s t y l e of l e a r n i n g t o cope w i t h t h e i r c h i l d . Tharp and Wetzel (1969) d e s c r i b e t h i s d a i l y c o n t a c t of the t h e r a p i s t ' s o r con-tingency manager i n the f o l l o w i n g manner: The task o f the contingency manager i n the complex s o c i a l environment i s thus to s p e c i f y the c o r r e c t p a t t e r n o f r e o r g a n i z e d c o n t r o l , and to modify the behavior o f the c o n t r o l l i n g people so t h a t they w i l l c o r r e c t l y r e o r g a n i z e f o r the u l t i m a t e b e n e f i t o f the d e v i a n t i n d i v i d u a l (p. 3). I n d i d i v u a l meetings can s t i l l be h e l d with the parents i f c r i s i s s i t u a t i o n s warrant i t but g e n e r a l l y the parents are allowed to operate here q u i t e independently o f the t h e r a p i s t . The parents are u s u a l l y by t h i s stage r e c e i v i n g r e i n f o r c e m e nt f o r t h e i r e f f o r t s from the t a r g e t e d c h i l d i n improved b e h a v i o r and from o t h e r s i n the c h i l d ' s environment who have c o n t a c t with the c h i l d . Improved r e l a t i o n s a t home o f t e n r e s u l t i n b e t t e r s c h o o l performance. Teachers and a d m i n i s t r a t i o n note improvement i n the c h i l d ' s behavior and u s u a l l y pass i t on to the parents a t home. Furthermore, improvements i n the c h i l d ' s b e h a v i o r make f o r a f r i e n d l i e r and more r e l a x e d atmosphere around the house. The f a m i l y can begin to do more t h i n g s t o -gether, o f t e n with l e s s f r i c t i o n . 69 Fading Out the T h e r a p i s t ' s Involvement By now the i n t e r v e n t i o n s t r a t e g y i s o f t e n i n t o i t s 9th o r 10th week. As the parents become more f a m i l i a r with the use of s o c i a l c o n t i n g e n c i e s and c o n t r a c t i n g they are b e t t e r a b l e t o cope with t h e i r c h i l d . The t h e r a p i s t ' s c ontact, which began w i t h home v i s i t s , p r i v a t e and group meetings, and phone c a l l s i s now p o s s i b l y o n l y a phone c a l l once or twice a week. Now the use of i n t e r m i t t e n t reinforcement by the parents to gradu-a l l y separate the c h i l d from token or p o i n t i n c e n t i v e c o n t r a c t -i n g system i s employed. I t may now be time f o r the t h e r a p i s t to meet wit h the parents and the c h i l d f o r a b r i e f review o f the past, a look at the p r e s e n t s i t u a t i o n , and maybe a prognosis f o r the f u t u r e . O v e r a l l , the t h e r a p i s t ' s emphasis should be on the pro g r e s s the parents and the c h i l d have made. The t h e r a p i s t then asks i f i t would be a l l r i g h t i f a c o l l e a g u e of h i s came i n t o t h e i r home i n about a week j u s t to check on the o r i g i n a l p r e s e n t i n g problems. I t i s e x p l a i n e d t h a t t h i s data, when compared to the b a s e l i n e data the parents c o l l e c t e d , w i l l h e lp the t h e r a p i s t and the c l i n i c tremendously and give them a c l e a r p i c t u r e o f whether or not the o r i g i n a l p r e s e n t i n g problem behaviors have been reduced i n frequency. B.2. Assessment of Change In almost any k i n d o f therapy one o b j e c t i v e or g o a l i s to demonstrate p o s i t i v e change i n the c l i e n t . The change i n the c l i e n t can come i n many forms. For example, depending upon one's t h e o r e t i c a l o r i e n t a t i o n , c l i e n t change can come i n the form o f i n s i g h t (Rogers, 1951), or a n a l y t i c t r a n s f e r e n c e (Freud, 1954). For most behavior t h e r a p i s t s change concerns i t s e l f w i t h a change i n behavior. Although behavior t h e r a p i s t s a l s o hope f o r c l i e n t awareness i n t h e i r i d e n t i f i c a t i o n of p a r t i c u l a r themes or p a t t e r n s o f thoughts, f e e l i n g s and b e h a v i o r , t h i s i s not t h e i r primary g o a l . Whereas more humanistic or. a n a l y t i c t h e r a p i s t s see as a goal the t r a n s l a t i o n of awareness i n t o be-h a v i o r a l a c t i o n and p l a n n i n g , most behavior t h e r a p i s t s see i t as q u i t e the o p p o s i t e p r o c e s s . I t i s behavior, and i t s i n c r e a s e or decrease, t h a t i s the s c a l e f o r measurement and i s used f o r determining change. I f the p r e s e n t model i s to be e f f e c t i v e a t a l l i t must demonstrate to the parents and the t h e r a p i s t t h a t the o r i g i n a l problem behaviors of the c h i l d have decreased i n frequency and p r o s o c i a l behaviors have i n c r e a s e d i n frequency. The b e s t means of determining the degree to which t h i s has been achieved i s by comparing a weeks o b s e r v a t i o n of the c h i l d ' s b e h a v i o r now, i n the post-treatment p e r i o d , to the data c o l l e c t e d d u r i n g the b a s e l i n e p e r i o d . For the b e s t p o s s i b l e r e l i a b i l i t y i n the o b s e r v a t i o n s the c o n d i t i o n s under which the f i r s t o b s e r v a t i o n s were made should be d u p l i c a t e d as c l o s e l y as p o s s i b l e d u r i n g the post-treatment o b s e r v a t i o n s . T h i s would seem to imply t h a t the parents should again c o l l e c t the data r a t h e r than a v i s i t i n g c o l l e a g u e of the t h e r a p i s t . However, my c l i n i c a l e xperience appears to i n d i c a t e t h a t the d i f f e r e n c e s i n who does the a c t u a l o b s e r v i n g are not as important as o t h e r v a r i a -71 b l e s such as the time of day o r what went on a t school t h a t day ( i e . b i r t h d a y s , h o l i d a y s , Monday versus F r i d a y ) . The demonstration o f p o s i t i v e change i n the i d e n t i f i e d c h i l d i s r e a l l y where a method o f i n t e r v e n t i o n proves i t s e l f . To f u r t h e r p r o p e r l y evaluate whether change has o c c u r r e d i n the c h i l d Graziano (1977) has the f o l l o w i n g c r i t e r i a : 1) The c h i l d ' s d i s t r e s s i n g behaviors have changed i n the d e s i r e d d i r e c t i o n . 2) New problem behaviors o r 'symptom s u b s t i t u t i o n ' have not o c c u r r e d . 3) The improved behaviors have somewhat g e n e r a l i z e d and become s t a b l e o u t s i d e the treatment s e t t i n g . 4) The improved behaviors are being maintained over a sub-s t a n t i a l p e r i o d o f time, o f , f o r example, 6-18 months. Graziano's (19 77) c r i t e r i a cover f o u r important areas f o r a s s e s s i n g whether change has o c c u r r e d i n a b e h a v i o r a l program. F i r s t , Graziano addresses the most obvious y a r d s t i c k f o r change. Have the i d e n t i f i e d problem b e h a v i o r s , i d e n t i f i e d d u r i n g the i n t a k e i n t e r v i e w , decreased i n frequency? Secondly, the pheno-menon of 'symptom s u b s t i t u t i o n ' , so o f t e n encountered i n be-h a v i o r m o d i f i c a t i o n programs, u s u a l l y r e s u l t s from the parent's i n e f f e c t i v e n e s s i n s p e c i f y i n g and r e i n f o r c i n g a p o s i t i v e a l t e r n a t i v e b e havior. That i s , through proper and c o n s i s t e n t r e i n f o r c e m ent of the c h i l d , p o s i t i v e behaviors w i l l grow s t r o n g e r and a n t i - s o c i a l behaviors w i l l f a l l i n frequency. T h i r d l y , whether the c h i l d ' s improved b e h aviors g e n e r a l i z e to o t h e r environments and s t a b i l i z e appears to-be more a q u e s t i o n o f time and the o v e r a l l e f f e c t i v e n e s s o f the parents as i n t e r v e n t i o n i s t s , r a t h e r than assessment. To f a c i l i t a t e a g e n e r a l i z a t i o n o f the c h i l d ' s new behaviors the t h e r a p i s t might, f o r example, want t o c a l l a group meeting with the c h i l d ' s t eachers a t which time a synopsis o f the p a s t i n t e r v e n t i o n s t r a t e g y w i t h the c h i l d i s given and the school's c o o p e r a t i o n s o l i c i t e d . A t times, such a move between the s c h o o l and the home can be made a t the very beginning o f treatment. In f a c t , such a c o o p e r a t i v e move on b e h a l f o f the parents and the t h e r a -p i s t i s recommended. Ful l m e r (1968) notes: 'The whole concept of f a m i l y c o n s u l t a t i o n and f a m i l y group c o n s u l t a t i o n i s based on the premise t h a t the work of the home and the s c h o o l are i n s e p a r a b l e ' (p. 20). T h e r e f o r e , w i t h time, c o o p e r a t i o n from o t h e r s , and e f f e c t i v e and c o n s i s t e n t mediation by the parent s , g e n e r a l i z a t i o n and s t a b i l i t y w i l l come to the t a r g e t e d behaviors of the c h i l d . F i n a l l y , Graziano's f o u r t h c r i t e r i a r e p r e s e n t s a goal most types o f t h e r a p i e s s t r i v e f o r . For any k i n d o f i n t e r v e n t i o n to be e f f e c t i v e i t s immediate p o s i t i v e r e s u l t s should endure over long p e r i o d s o f time (3 months - 24 months) wit h l i t t l e r e l a p s e o r r e e n t r y i n t o treatment. The presen t model d e a l s with t h i s l a s t p o i n t by sugges t i n g e f f i c i e n t c o n s u l t a t i v e follow-up and 'Booster Shots' (Fleischman and Conger, 1978) which w i l l be examined i n the f i n a l s e c t i o n c a l l e d C o n s u l t a t i v e follow-up. 73 C. E v a l u a t i o n C I . C o n s u l t a t i v e Follow-Up C o n s u l t a t i v e follow-up r e a l l y d e s c r i b e s two processes i n one. T h i s component c o u l d read C o n s u l t a t i o n and Follow-Up. Here, the t h e r a p i s t i s i n v o l v e d i n f o l l o w i n g the f a m i l y ' s progress over a v a r y i n g l e n g t h o f time. Fleischman and Conger (1978) d i v i d e t h e i r p e r i o d of m o n i t o r i n g the f a m i l y and f o l l o w -i n g t h e i r p rogress i n t o three home o b s e r v a t i o n s e s s i o n s at the 4th, 8th and. 12th months p l u s an a s s i s t a n t c a l l i n g the home once a week f o r a year. The emphasis here i s on b e h a v i o r a l data t h a t w i l l a s s i s t the c l i n i c i a n s i n improving t h e i r i n t e r v e n t i o n s t r a t e g i e s . On the oth e r hand, the parents are a l s o made aware of f u r t h e r a s s i s t a n c e t h a t i s a v a i l a b l e t o them. 'Booster shots" are i n v o l v e d i n what Fleischman and Conger (1978) c a l l the c r i s i s t h a t the t h e r a p i s t e n t e r s a f t e r formal treatment w i t h the f a m i l y has ended. They note t h a t approximately 1/4 o f t h e i r f a m i l i e s needed such a s s i s t a n c e a t some p e r i o d s h o r t -l y a f t e r t e r m i n a t i o n . However, w i t h a thorough follow-up by a concerned t h e r a p i s t o r team of c l i n i c i a n s these c r i s e s can sometimes be avoided. With regard to the presen t model, follow-up may not have to be as e x t e n s i v e as the approach taken by Fleischman and Conger. The blue c o l l a r f a m i l y would most l i k e l y r e s e n t such weekly i n t r u s i o n s i n t o t h e i r home l i f e and w i t h t h e i r o r i g i n a l problems somewhat a l l e v i a t e d they would probably j u s t as soon go on w i t h t h e i r onw l i v e s . Follow-up would have a t i m e t a b l e of two home v i s i t s i n the f i r s t month a f t e r t e r m i n a t i o n and 74 t h e n o n e home v i s i t a m o n t h f o r t h e n e x t 2 m o n t h s . The p a r e n t s w o u l d u n d e r s t a n d t h a t t h e i r q u e s t i o n s a n d / o r p r o b l e m s a r e w e l -come a t a n y t i m e d u r i n g t h e 3 m o n t h f o l l o w - u p b y t h e c l i n i c a n d t h e r a p i s t a t n o o b l i g a t i o n t o t h e m . 75 Chapter IV Summary and Conclusions  Overview The o v e r a l l o b j e c t i v e of the p r e s e n t i n v e s t i g a t i o n was to develop a model which p r o v i d e s a s t r a t e g y f o r i n t e r v e n t i o n w i t h the blue c o l l a r f a m i l y . In Chapter I I , the framework f o r the model was e s t a b l i s h e d by examining r e l e v a n t l i t e r a t u r e and r e -search i n the areas o f ; a) the use o f parents as change agents f o r t h e i r c h i l d r e n , b) the c h a r a c t e r i s t i c s o f the blue c o l l a r f a m i l y , and c) a behavior m o d i f i c a t i o n approach. Furthermore, my c l i n i c a l experience p r o v i d e d support i n e s t a b l i s h i n g the b a s i c framework f o r the model as w e l l as d e c i d i n g upon the f i n a l components f o r the model. Chapter 111 began w i t h the development o f a r a t i o n a l e f o r the a d d i t i o n of a humanistic Rogerian (1951) approach to the behav-i o r a l o r i e n t a t i o n a l r e a d y o u t l i n e d . I t was proposed t h a t the combination of these two d i v e r g e n t approaches i s important to a s u c c e s s f u l method of i n t e r v e n i n g e f f e c t i v e l y with the b l u e c o l l a r f a m i l y . F o l l o w i n g t h i s the components f o r the model o f i n t e r v e n -t i o n w i t h b l u e c o l l a r f a m i l i e s were i n t r o d u c e d under the three main headings o f A. Assessment, B. Treatment and C. E v a l u a t i o n . The model, i n c l u d i n g i t s s u b - s e c t i o n s , i s as f o l l o w s : Proposed A l t e r n a t i v e Model A. Assessment 1) . R o l e - I n d u c t i o n Interview 2) . Intake Interview 3) . 3 a s e l i n e B. Treatment 4) . Parent T r a i n i n g Sessions 5) . Assessment of Change C. E v a l u a t i o n 6) . C o n s u l t a t i v e Follow-Up The model i n Chapter I I I p r e s e n t s the blue c o l l a r f a m i l y with a s t r u c t u r e t h a t i s t a i l o r e d to c e r t a i n d e f i n a b l e charac-t e r i s t i c s of t h e i r p o p u l a t i o n . Researchers, such as Wilson and Evans (1977) and G o l d s t e i n e t a l (1966), advocate t h a t to ensure a p r o d u c t i v e degree o f expectancy and t o a v o i d c l i e n t overcon-f i d e n c e , the b e s t s o l u t i o n i s to s t r u c t u r e the therapy f o r the c l i e n t . Many of G o l d s t e i n ' s proposed steps i n s t r u c t u r i n g a treatment are i n c l u d e d i n the model presented i n t h i s paper. They i n c l u d e ; a) an o v e r a l l p e r s u a s i v e r a t i o n a l e f o r the s p e c i -f i c treatment methods t h a t are employed, b) an e x p l a n a t i o n of the development, maintenance, and m o d i f i c a t i o n of the f a m i l y ' s problems, and c) a d e s c r i p t i o n of the p r o c e d u r a l steps i n v o l v e d and the parent's own r e s p o n s i b i l i t i e s i n a c t i v e l y p a r t i c i p a t i n g i n the treatment. Some G u i d e l i n e s Regarding The A p p l i c a t i o n o f the Model I t has been p o i n t e d out t h a t t h i s i n t e r v e n t i o n s t r a t e g y i s a model and not a program to be f o l l o w e d i n a step-by-step f a s h i o n . A program o f i n t e r v e n t i o n would be more d e t a i l e d i n c o v e r i n g each step so the reader would h o p e f u l l y have fewer qu e s t i o n s as to i t s a p p l i c a t i o n . I b e l i e v e t h i s model p r o v i d e s important p o i n t s i n p r o v i d i n g a framework o f e f f e c t i v e i n t e r -77 v e n t i o n w i t h t h e d y s f u n c t i o n a l b l u e c o l l a r f a m i l y . A l l c o m -p o n e n t s a n d s u b s e c t i o n s o f t h e p r e s e n t m o d e l a r e i m p o r t a n t a n d s h o u l d b e a p p l i e d i n t h e o r d e r i n w h i c h t h e y a r e p r e s e n t e d . H o w e v e r , t h e r e a r e c e r t a i n i m p o r t a n t g u i d e l i n e s t h a t s h o u l d b e c o n s i d e r e d w h e n e x a m i n i n g a n d a p p l y i n g t h e m o d e l p r e s e n t e d i n C h a p t e r I I I . T h e s e g u i d e l i n e s a r e l i s t e d a n d e x p l a i n e d b e l o w . 1.) A g e o f t h e C h i l d . P e r h a p s t h e m o s t i m p o r t a n t a s p e c t t o c o n s i d e r i n a p p l y i n g t h e m o d e l t o t h e b l u e c o l l a r f a m i l y i s t h e a g e o f t h e i d e n t i f i e d c l i e n t o r t a r g e t c h i l d . T h r o u g h p e r s o n a l e x p e r i e n c e a n d c o n s u l t a t i o n w i t h o t h e r s i n t h e f i e l d o f f a m i l y c o u n s e l l i n g u s i n g a b e h a v i o r a l a p p r o a c h , I b e l i e v e t h a t t h e a p p r o a c h d e s c r i b e d i n t h i s p a p e r i s m o s t e f f e c t i v e w i t h p r e - a d o l e s c e n t c h i l d r e n . I t a p p e a r s f r o m m y c l i n i c a l e x p e r i -e n c e t h a t t h e e l e m e n t a r y s c h o o l a g e d c h i l d p r e s e n t s a m u c h b e t t e r o p p o r t u n i t y f o r s u c c e s s , - u s i n g a b e h a v i o r a l a p p r o a c h , t h a n a n a d o l e s c e n t c h i l d . T h e r e v i e w e d r e s e a r c h f o r t h i s p a p e r , h o w -e v e r , d o c u m e n t s n o c l e a r e v i d e n c e t o b a c k - u p t h i s c l a i m . T h e r e a s o n s f o r t h e r e l a t i v e l a c k o f p o s i t i v e e f f e c t s u s i n g a b e h a v i o r a l a p p r o a c h w i t h a d o l e s c e n t s a r e p r o b a b l y m a n y . P e r -h a p s o n e i m p o r t a n t r e a s o n f o r t h e p o o r s u c c e s s r a t e i n a p p l y i n g a b e h a v i o r m o d i f i c a t i o n a p p r o a c h w i t h a d o l e s c e n t s h a s t o d o w i t h t h e m a n y d i f f i c u l t i s s u e s f a c e d b y a d o l e s c e n t s . A d o l e s c e n c e f i n d s t h e c h i l d i n a s t a t e o f t r a n s i t i o n f r o m c h i l d h o o d t o a d u l t -h o o d . L a u f e r (1975) b r e a k s a d o l e s c e n c e i n t o 3 s t a g e s . T h e a g e s o f 12-15 y e a r s , 15-18 y e a r s o f a g e a n d 18-21 y e a r s o f a g e . A t e a c h s t a g e L a u f e r n o t e s t h e c h i l d ' s r e s i s t a n c e t o h i s o r h e r 78 parents. For example, i n the years from 15-18 the c h i l d ' s , '...main s t r e s s e s r e v o l v e around the a d o l e s c e n t ' s e f f o r t s to become e m o t i o n a l l y independent o f the parents. He begins to f e e l t h a t thoughts, wishes and a c t i o n s are no l o n g e r d e t e r -mined by the e x p e c t a t i o n s o f h i s par e n t s . Contemporaries now become more important i n d e c i d i n g what i s a c c e p t a b l e o r un-acc e p t a b l e (p. 21).' The f i r s t and the l a s t stages mark the beginnings and the end o f t h i s independence from the par e n t s . The T r i a d i c Model s t r e s s e s the importance o f the parent as the mediator. Adolescence would appear t o be a time when t h i s important l i n k i s s e v e r e l y t e s t e d . I t appears the parents now h o l d f a r fewer of the r e i n f o r c e r s they possessed b e f o r e the c h i l d was a teenager. Many of the t h i n g s t h a t were once very important to the c h i l d are now not so important i n adolescence and the s p o t l i g h t has s h i f t e d from the parents and the home to the c h i l d ' s peers and h i s or her environment o u t s i d e o f the home. My p o i n t r e g a r d i n g the ado l e s c e n t stage i s not t h a t the parents have l e s s c o n t r o l over t h e i r c h i l d . I simply wish to guard a g a i n s t e x p e c t i n g the same k i n d of r e s u l t s i n a p p l y i n g the model wi t h a d o l e s c e n t s as with a p p l y i n g the model w i t h elementary school aged c h i l d r e n . The person(s) who can now take on the r o l e of the mediator has probably s h i f t e d to some-one o u t s i d e of the home and o n l y through c a r e f u l i n v e s t i g a t i o n by the t h e r a p i s t can these people be l o c a t e d and p r o p e r l y u t i l i -zed. I b e l i e v e t h a t d u r i n g adolescence the c h i l d ' s n a t u r a l developmental focus i s to break some of the bonds with the parents so as to enable h i m s e l f o r h e r s e l f the autonomy to begin to grow as a young a d u l t . 2) . The importance o f the Parent Mediator. The parents h o l d the key to success i n the i n t e r v e n t i o n s t r a t e g y suggested i n t h i s r e s e a r c h . The m o t i v a t i o n of the parents to c a r r y out the many tasks they are asked to do i s a p o i n t o f const a n t concern to the t h e r a p i s t and t h e r e f o r e the parents are the focus o f the t h e r a p i s t ' s a t t e n t i o n and encouragement. Bandura (1971) notes t h a t the use o f the parents as e f f e c t i v e mediators i n the t h e r -apy ensures, '...more genuine and enduring r e l a t i o n s h i p e xperiences than thos d e r i v e d from a purchased r e l a t i o n s h i p p r o v i d e d by a busy p r o f e s s i o n a l t h e r a p i s t at b r i e f weekly i n -t e r v a l s (p. 697).' Furthermore, any pr o g r e s s , no matter how smal l o r seemingly i n s i g n i f i c a n t , i s a t t r i b u t e d t o the d e d i c a -t i o n and work o f the parents and not t o the t h e r a p i s t o r any theory o r model t h a t may have been used (P a t t e r s o n , 19 75) . 3) . Some C h a r a c t e r i s t i c s o f The T h e r a p i s t . A very impor-t a n t q u a l i t y o f the t h e r a p i s t i n the pr e s e n t model i s h i s or her degree of e x p e r t i s e i n the p r a c t i c e of f a m i l y therapy o r coun-s e l l i n g . The t h e r a p i s t should be p r o f e s s i o n a l l y t r a i n e d i n the use o f empathy, u n c o n d i t i o n a l p o s i t i v e r e gard and genuiness. Furthermore, Wilson and Evans (1977) p o i n t out t h a t the behavior t h e r a p i s t i s more o f a c o n s u l t a n t than a c o n t r o l l e r o f p a s s i v e respondents to e x t e r n a l f o r c e s . The t h e r a p i s t advises and en-courages the parents i n a c t i v e , p r o b l e m - s o l v i n g s t r a t e g i e s i n -v o l v i n g themselves and t h e i r c h i l d r e n . 80 The b e s t s o l u t i o n , then, i s f o r the t h e r a p i s t to have a c e r t a i n f a c i l i t y i n r e l a t i n g to a number of d i f f e r -ent types of person. These i n t e r p e r s o n a l s k i l l s have the consequence of i n c r e a s i n g a t t r a c t i v e n e s s and thus a b i l i t y to i n f l u e n c e : i t i s i n t h i s way t h a t such t h e r a p i s t c h a r a c t e r i s t i c s as empathy, warmth, and so f o r t h , are c o n s i d e r e d important i n behavior therapy (Wilson and Evans, 1 9 7 7 , p. 5 5 3 ) . One o t h e r c h a r a c t e r i s t i c of the t h e r a p i s t t h a t c o u l d prove of some importance i n the treatment of the f a m i l y i s h i s or her m a r i t a l s t a t u s . A married s t a t u s of the t h e r a p i s t may prove to be advantageous when p r a c t i s i n g any k i n d of f a m i l y therapy j u s t as i t can sometimes be b e n e f i c i a l t o be married to p r a c t i c e m a r i t a l therapy. One reason f o r t h i s i s t h a t the c l i e n t s are sometimes, but not always, more p e r s o n a l l y assured t h a t the t h e r a p i s t understands t h e i r s i t u a t i o n because he o r she i s a l s o m a r r ied and has c h i l d r e n . In f a c t , from a t h e r a -p i s t ' s viewpoint there can be i n s t a n c e s where being married can prove to be a r e a l a s s e t i n f a m i l y therapy because i t allows f o r more s e l f - d i s c l o s u r e (Egan, 1 9 7 5 ) by the t h e r a p i s t . 4.) The Model and What Types o f Problems? The proposed model advocates a s p e c i f i c approach, f o r a s p e c i a l type of problem, f o r a c e r t a i n type of c l i e n t . The approach concerns i t s e l f w i t h the combination of a b e h a v i o r m o d i f i c a t i o n s t y l e and a Rogerian o r i e n t a t i o n . The model should f i n d i t s broadest a p p l i c a t i o n with a blue c o l l a r f a m i l y . The type of problem the t h e r a p i s t should c o n s i d e r workable under the p r e s e n t model would i n v o l v e a p r e - a d o l e s c e n t c h i l d who e x h i b i t s observable and d e f i n a b l e behaviors which are c a u s i n g problems to the parents and are happening a t a r a t e which would not be c o n s i d e r e d 81 normal f o r a c h i l d of t h a t age, sex and background. Werry and Wollersheim (1967) d e s c r i b e f o u r c r i t e r i a f o r u s i n g a b e h a v i o r m o d i f i c a t i o n approach.: 1. ) where there are d i s c r e t e , e a s i l y r e c o g n i z a b l e symptoms o r problem b e h a v i o r s . 2. ) where, because o f c l i n i c a l c o n d i t i o n s or mental age, the c l i e n t i s not s u i t a b l e f o r a more v e r b a l i z e d approach such as a p s y c h o a n a l y t i c o r c l i e n t - c e n t e r e d approach. 4.) where p r o f e s s i o n a l t h e r a p i s t s are s c a r c e and, because of i t s s y s t e m a t i c and concrete nature, behavior therapy can be r e a d i l y executed by r e l a t i v e l y u n s k i l l e d parents w i t h some-degree o f s u p e r v i s i o n and c o n s u l t a t i o n . With a blue c o l l a r s t y l e of i n t e r v e n t i o n the parents f i n d themselves e n j o y i n g p a r t i c u l a r b e n e f i t s from a therapy employing behavior m o d i f i c a t i o n techniques and p r i n c i p l e s . F i v e advan-tages o f t h i s approach l i s t e d by Carkhuff (19 71) are 1. ) They p r o v i d e the parent with a system of w e l l - d e f i n e d and w e l l - o r g a n i z e d procedures. 2. ) They o u t l i n e f o r the parent a d e f i n i t e r o l e f o r them to p l a y i n the treatment. 3. ) They pr o v i d e the parents w i t h a h i g h and extremely u s e f u l l e v e l of confidence i n what they are doing and where they are going. 4. ) They begin to p r o v i d e o r d e r to a p r e v i o u s l y d i s o r g a n i z e d household. 5. ) They . p r o v i d e the parents with a s p e c i f i c b e h a v i o r a l base from which to begin to understand t h e i r c h i l d ' s b e h a v i o r . 82 5.) Assessment Before I n t e r v e n t i o n . At the very beginn-i n g o f therapy, a t the moment o f r e f e r r a l , one of the t h e r a -p i s t ' s f i r s t concerns should be to make an accurate assessment o f whether or not the i d e n t i f i e d c l i e n t r e a l l y i s the problem i n t h i s f a m i l y . Simply because a c h i l d i s r e f e r r e d to the t h e r a p i s t i t cannot be assumed t h a t the c h i l d r e a l l y i s the problem. The t h e r a p i s t should f i r s t o f a l l c a r e f u l l y examine what the b e l i e f s and a t t i t u d e s of the r e f e r r i n g parents are i n regard to t h e i r c h i l d and what expectancies they h o l d r e g a r d i n g both h i s / h e r behavior as w e l l as t h e i r own. A b i d i n (19 75) notes; S u c c e s s f u l c o n s u l t i n g demands that the c o n s u l t a n t be s e n s i t i v e to the value s and b e h a v i o r a l expectancies of the c o n s u l t e e and be cog n i z a n t o f the l i m i t a t i o n s p l a c e d on the c o n s u l t e e by the values and b e h a v i o r a l c o n t i n g e n c i e s o f the s o c i a l system i n which he works (p. 363). How T h i s Model i s Unique From Other  Models o f Family I n t e r v e n t i o n Much o f the very b a s i c framework f o r the model was a r r i v e d a t by e c l e c t i c a l l y borrowing ideas from r e s e a r c h by ot h e r s such as P a t t e r s o n (1975), Tharp and Wetzel (1969), Carkhuff (1967) and G o l d s t e i n (1966). However, the s i x components i n the model are new i n t h e i r p a r t i c u l a r arrangement. The model a l s o took shape from a review o f r e l a t e d r e s e a r c h i n c o n s u l t a -t i o n and one-to-one c o u n s e l l i n g . At one p o i n t I thought I had a unique i d e a o f combining behavior therapy with Rogerian therapy o n l y to d i s c o v e r through f u r t h e r i n v e s t i g a t i o n t h a t S a d l e r and Seyden (1975) had three years e a r l i e r advocated a 83 s i m i l a r combination. However, the combination, i n v e s t i g a t e d i n the p r e s e n t model has much more o f a b e h a v i o r a l o r i e n t a t i o n than the program proposed by S a d l e r and Seyden. Furthermore, n e i t h e r P a t t e r s o n ' s (1975) nor Fleischman and Conger's (1978) proposed models i n c l u d e e x a c t l y the same component arrangements as the model presented. What does make the present model unique i n i t s scope and d i r e c t i o n i s the p o p u l a t i o n f o r which i t i s intended. L i t e r a -t u re r e l a t e d t o the blue c o l l a r f a m i l y was examined c l o s e l y to determine what s t y l e of therapy would prove most e f f e c t i v e . In Chapter I I the recommended treatment approach f o r t h i s popula-t i o n i s c l e a r l y o u t l i n e d and then combined wi t h the behavior m o d i f i c a t i o n o r i e n t a t i o n . I b e l i e v e the r e s u l t o f t h i s union suggests a v i a b l e approach to i n t e r v e n i n g with the b l u e c o l l a r f a m i l y . I m p l i c a t i o n s f o r F u r t h e r Research The model of i n t e r v e n t i o n presented i n t h i s paper has many i m p l i c a t i o n s f o r f u r t h e r r e s e a r c h . F i r s t , a comparison of the p r e s e n t model a p p l i e d i n a c l i n i c a l s e t t i n g to o t h e r models of i n t e r v e n t i o n would seem a p p r o p r i a t e . T h i s would i n -v o l v e t e s t i n g the r e l a t i v e e f f e c t i v e n e s s o f t h i s model a g a i n s t other s t y l e s of f a m i l y therapy w i t h blue c o l l a r f a m i l i e s . For example, a comparison o f the present model w i t h a humanistic or v e r b a l approach model or a behavior m o d i f i c a t i o n model, might produce v a l u a b l e r e s u l t s f o r the f i e l d o f family-. therapy. 84 A second suggestion f o r f u r t h e r r e s e a r c h i s noted by Tharp and Wetzel (1969) r e g a r d i n g the importance of the mediators. Tharp and Wetzel suggest a study i n v o l v i n g the f u n c t i o n a l r e -l a t i o n s h i p between aspects o f the parent's behavior and c e r t a i n aspects o f the c o n s u l t a n t ' s behavior; an i n v e s -t i g a t i o n i n t o the i n t e r a c t i o n o r dynamics between the t h e r a p i s t and the parents. What makes f o r a s u c c e s s f u l a l l i a n c e o r working r e l a t i o n s h i p and what does not? T h i s concept c o u l d a l s o be a p p l i e d to the r e l a t i o n s h i p between the parent and the c h i l d . An i n t e n s i v e study d i r e c t e d a t what a c t u a l l y happens when the c h i l d and the parent i n t e r a c t and what i n the i n t e r a c t i o n causes the parent and the c h i l d to behave i n a c e r t a i n f a s h i o n c o u l d a l s o prove to be extremely i n f o r m a t i v e . Two oth e r i m p l i c a t i o n s f o r f u r t h e r r e s e a r c h r e g a r d i n g the proposed model would i n c l u d e an i n v e s t i g a t i o n r e g a r d i n g the model's components. Research c e n t e r i n g around whether o r not c e r t a i n components were a b s o l u t e l y e s s e n t i a l to the model or whether c e r t a i n p a r t s o f the model co u l d be l e f t out would appear important as f a r as s h o r t e n i n g the o v e r a l l time of i n t e r v e n t i o n . Another i n t e r e s t i n g avenue o f i n v e s t i g a t i o n would focus on the i s s u e o f the age of the c h i l d and/or the socioeconomic l e v e l o f the f a m i l y . An i n v e s t i g a t i o n comparing d i f f e r e n t ages of the t a r g e t c h i l d and the a p p l i c a t i o n o f the model to middle-c l a s s and u p p e r - c l a s s f a m i l i e s may r e v e a l t h a t the model has a broader a p p l i c a t i o n than I p r e s e n t l y e n v i s i o n . 85 REFERENCES Adandam, K. and Williams, R.L. A model for consultation with classroom teachers on behavior management, The School Counselor 1971, 18, 258-259. Adler, A l f r e d . Understanding human nature, New York; Garden City Publishing Co., 1927. Allyon, T., and Michael, J. The p s y c h i a t r i c nurse as a behavioral engineer. Journal of Experimental Analysis Behavior. 1959, 2, 323. American Psychological Association. Publication manual. 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