ACT and Applied Behavior Analysis: A Practical Guide to Ensuring Better Behavior Outcomes Using Acceptance and Commitment Training 1684035813, 9781684035816

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PSYCHOLOGY

As a board-certified behavior analyst (BCBA or BCaBA), your clients have a wide range of language skills—from nonspeaking to very fluent. To ensure the best behavior outcomes, you need a flexible therapeutic framework to fully engage with all clients—as well as their families. This comprehensive professional guide offers a proven-effective program grounded in acceptance and commitment therapy (ACT) and relational frame theory (RFT) to help you expand the effectiveness of your practice and deliver exceptional care.

With ACT and Applied Behavior Analysis, you’ll learn to conceptualize your cases using ACT, create your own client exercises, generate metaphors, and be fully present with each unique client. By integrating core ACT skills—including mindfulness, flexible perspective taking, committed action, and values work—you’ll be ready to take your applied behavior analysis (ABA) practice to the next level. You’ll also find information on cultural competency and diversity to further broaden the scope and effectiveness of therapy. If you’re looking for skills and strategies to enhance your ABA practice, this book has everything you need to get started.

“This book is a must-read for anyone seeking to integrate ACT into their practice as a BCBA.”

ACT and Applied Behavior Analysis

A Comprehensive Guide to Using ACT in Applied Behavior Analysis

—Steven C. Hayes, PhD, originator of ACT

A Practical Guide to Ensuring Better Behavior Outcomes Using Acceptance and Commitment Training

ACT and Applied

Behavior Analysis • Explore the roots of ACT • Create client-specific exercises and metaphors

Thomas G. Szabo, PhD, BCBA-D, is a professor at Capella University’s ACT trainer, and a board-certified behavior analyst.

Szabo

master’s and doctoral behavior analysis programs, an internationally recognized

Context Press

• Work collaboratively with clients, parents, and interventionists • Promote values-driven behavior

Thomas G. Szabo, PhD, BCBA-D

An Imprint of New Harbinger Publications, Inc. www.newharbinger.com

Context

Press

Foreword by Jonathan Tarbox, PhD, BCBA-D

“Applied behavior analysis (ABA) has waited a long time for this book. Behavior analysts will be delighted at the clear, pragmatic approach this book takes in guiding them toward the incorporation of acceptance and commitment therapy (ACT) into behavior analytic practice. The many examples and vignettes are relevant and representative. The book underscores how ACT synthesizes with the behavior analyst’s competencies, including implementing inter­ ventions based on functional analysis. The writing style is engaging, and will keep the reader smiling.”  —Ruth Anne Rehfeldt, dean at Waubonsee College; past president of the Association for Behavior Analysis International; and fellow of the Associations for Behavior Analysis and Contextual Behavior Science 

“ACT emerged from behavior analysis, but ironically it is only now being used by mainstream ABAs. This book provides an in-depth overview of ACT in an ABA context, along with practical exercises to help practitioners develop their skills in functional assessment, analysis, and intervention. The chapters on the six repertoires of psychological flexibility are particu­ larly valuable, as they provide competencies and exercises that can help ABA practitioners evaluate their current repertoire and further their training. This book is a must-read for anyone seeking to integrate ACT into their practice as a BCBA, and, as the author’s personal story illustrates, to practice what they preach in their own lives.”  —Steven C. Hayes, PhD, emeritus professor of psychology at the University of Nevada, Reno; and originator of ACT 

“In the era of compassionate and trauma-informed care, the brief ACT functional analysis and other tools presented in this book are instrumental to the meaningful practice of ABA. I would even go as far as saying, the tools provided in this book may be the way for behavior analysts to find their heart (Wolf, 1978), in that its utilization will undoubtedly lead to socially significant behavior change.”  —Michele D. Wallace, PhD, BCBA-D, professor at Cal State LA; and coauthor of Behavior Analysis for Lasting Change, Principles of Applied Behavior Analysis for Behavior Technicians and Other Practitioners, and Behavioral Consulting 

“Mera dil khush hogaya—my heart is happy. If you are a BCBA searching for a practical guide to ACT, this is your book—your go-to, dog-eared, nightstand stuff. Tom’s writing is like brewing the perfect chai: two tablespoons of theory, two cups of practice, and plenty of kindness.” —Sehar Moughal, Doctoral Candidate, BCBA, registered psychologist, and professional teaching fellow at the University of Auckland 

“With its transformative approach, practical exercises, and insightful examples, this invalu­ able guide rewards practitioners with enhanced skills, personal growth, and the ability to make a meaningful impact with compassion and respect. Embrace the power of ACT in ABA to foster psychological flexibility in clients, caregivers, colleagues, stakeholders, and yourself. Join a community of practitioners dedicated to making a difference, and be rewarded with profound professional and personal fulfillment.” —Yukie Kurumiya, PhD, BCBA-D, IBA, contextual behavior analyst at the Chicago School of Professional Psychology, and founder of ACT Prosocial Design 

“ACT and Applied Behavior Analysis clarifies the connection between ACT and the science of behavior by sharing information and exercises that equip readers with the necessary compo­ nent skills for practicing acceptance and commitment training in the field of ABA. This is a must-have book for ABA practitioners who seek to develop a practice repertoire that includes increased awareness and insight into self, compassion, and humility.” —Nasiah Cirincione Ulezi, EdD, BCBA, CEO and founder of ULEZI, LLC 

“Tom Szabo takes readers through history, concepts, and principles by providing evidence from laboratory and applied research, sharing valuable examples from his experience, and outlining practical case conceptualizations that are relatable and memorable. Throughout this book, Tom calls on all behavior analysts to self-reflect and take action.” —Ellie Kazemi, PhD, international speaker, organizational management consultant, and professor of behavior analysis in the department of psychology at CSUN 

“Tom Szabo’s book, ACT and Applied Behavior Analysis, takes you on a journey of human experience. You will be grounded in the philosophical underpinnings of the science, and then explore the complexities of verbal behavior. The expertise shared enriches the practice of behavior analysis beyond the operant chamber and demonstrates that ACT and the science of behavior are robust, responsive, and may be leveraged to positively impact for all.” —Margaret Uwayo, PhD, BCBA, LBA, executive director of Kalamazoo Academy for Behavioral and Academic Success, and senior director of behavioral and academic success at YWCA Kalamazoo

ACT

and Applied Behavior Analysis A Practical Guide to Ensuring Better Behavior Outcomes Using Acceptance and Commitment Training

Thomas G. Szabo, PhD, BCBA-D

Context Press

An Imprint of New Harbinger Publications, Inc.

Publisher’s Note This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional services. If expert assistance or counseling is needed, the services of a competent professional should be sought. NEW HARBINGER PUBLICATIONS is a registered trademark of New Harbinger Publications, Inc. New Harbinger Publications is an employee-owned company. Copyright © 2023 by Thomas G. Szabo Context Press An imprint of New Harbinger Publications, Inc. 5720 Shattuck Avenue Oakland, CA 94609 www.newharbinger.com All Rights Reserved Cover design by Sara Christian Acquired by Ryan Buresh Edited by Karen Levy

Library of Congress Cataloging-in-Publication Data on file

Printed in the United States of America 25  24  23 10  9  8  7  6  5  4  3  2  1

First Printing

To my father, who cheered me on through my darkest days and somehow never lost faith in me.

Contents



Forewordvii



Introduction1

Chapter 1 ACT in ABA, the Research That Got Us Here, and an RFT Primer5 Chapter 2 The View from Above: Six Repertoires to Practice Before the Going Gets Tough21 Chapter 3 ACT Functional Assessment and Functional Analysis35 Chapter 4 Learning ACT: A Three-Stage Plan69 Chapter 5 The ACT Matrix: A Launchpad for Other Activities77 Chapter 6 Metaphors91 Chapter 7 Active Exercises111 Chapter 8 Willingness119 Chapter 9 Defusion151 Chapter 10 Present Moment Awareness169 Chapter 11 Flexible Perspective-Taking193 Chapter 12 Valuing215 Chapter 13 Committed Action233 Chapter 14 Scope of Practice for the Behavior Analyst Using ACT255

vi



ACT and Applied Behavior Analysis

The Future Is Green265

Appendix The ABA ACT Core Competency Rating Form267

Acknowledgments272



References273



Index279

Foreword

I had the extraordinary fortune, purely by chance, to study for my PhD at the same university where acceptance and commitment therapy (ACT) was developed, the University of Nevada at Reno, so I started reading and casually thinking about ACT a little over twenty years ago. However, I suffered from the all-too-common misconception that, if you could not define some­ thing easily in behavior analytic terms, then “it must not be real behavior analysis.” I wanted to learn about ACT and I believed it was important, but it didn’t pass my rigid criteria about what made something “real behavior analysis.” After spending years grappling with conceptually analyzing the ACT hexaflex in terms of behavioral principles, I finally felt as though I “got it” reasonably well. I came to the conclusion that Steve Hayes or Kelly Wilson could have casually told me ten years before, had I simply asked: “Yes, ACT is behavior analysis. It came from behavior analysis and a behavior analytic understanding of human language, and it is still behavior analysis because proper ACT training involves analyzing, conceptualizing, and design­ ing ACT interventions in terms of behavioral principles.” And so, about ten years ago, I found myself ready to seek out formal training in ACT. At the time, precious few behavior analysts were training others in ACT and no trainings, what­ soever, were publicly available that were specifically designed for professionals in applied behav­ ior analysis (ABA). I was fortunate enough to stumble upon the opportunity to be trained by Dr. Lisa Coyne, assisted by two of Steve Hayes’s graduate students at the time, Douglas Long and Tom Szabo. During this weeklong training, I was immediately impressed by Tom’s ability to make the ACT concepts and procedures accessible to me, both on a practical level and on a purely behavior analytic conceptual level. Unbeknownst to me, Tom had been conducting ACT trainings for behavior analysts and staff working with individuals with developmental dis­ abilities for some time and had already developed a skilled training repertoire. This was in 2013. Shortly after my initial training experience with Tom, he finished his PhD and further expanded his training and consultation practice. Three years later, in the fall of 2016, I found myself shaking with fright on a stage while assisting Tom in training behavior analysts in ACT. It was horrifying. I was sure, damned sure, that I wasn’t ready and I didn’t belong there. I still remem­ ber, clear as day, that I felt like I had ants crawling all over me. But I had already tried to avoid this opportunity in conversation with Tom multiple times and he had shown me the evidence that argued that I could be of service, and so there was nothing left for me to do but take that one small horrifying step. Step up and be scared, be imperfect. My career has never been the same since. Now, seven years later, it is my great pleasure to be asked to write the foreword for this book, a book that the field of ABA has needed for many years.

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ACT and Applied Behavior Analysis

But why a book on ACT for behavior analysts by Dr. Thomas Szabo? Tom has a rare com­ bination of skills that uniquely qualify him to write this book. Tom is among the very few people in the world who have deep knowledge in basic research, applied research, real-life practice, and the conceptual bedrock that forms the foundation for all three. For example, precious few people can weave together concepts such as the matching law, delay discounting, and behav­ ioral momentum, while discussing how elementary verbal operants grow into complex genera­ tive relational framing behavior, all in the context of an autistic child striving to navigate a social world designed and controlled by neurotypicals who don’t understand them and treat them as “less than” because they are different. Tom’s repertoire of simultaneous great depth and breadth within behavior analysis is uniquely critical for writing the first major book on ACT for behavior analysts because ACT pushes us to expand applied behavior analysis into levels of complexity that have rarely been attempted in the past. This expansion cannot be carried out by simply implementing ACT procedures commonly used in clinical psychology and praying that they produce behavior change. To continue in the vein of Baer, Wolf, and Risley’s (1968) vision for applied behavior analysis, we must be conceptually systematic by ushering ACT into ABA through a behavior analytic conceptual understanding built on a firm foundation of behavioral principles. Tom Szabo is among the very few humans who have been leading the charge in developing a thor­ oughgoing behavior analytic approach to ACT, and his work over the past years shines through in the detailed, subtle, nuanced approach that this book offers. This book is not just about offering procedures; it is also about helping us understand the why and how that underlie effec­ tive ACT training in ABA, so that all of us can play a part in producing the next evolution of ACT in ABA. However, being conceptually sophisticated is not enough. What practitioners in ABA really need are tools that make sense and actually work in the real world. These tools are the heart and soul of this book. These tools will empower practitioners to take small but meaning­ ful steps toward supercharging their practice with greater meaning, purpose, and presence. The reader might wonder, Where did these practical tools come from? Tom has been training real-life practitioners in the field for many years, from the time he was a PhD student at the University of Nevada, Reno, under the tutelage of ACT cofounder Dr. Steven C. Hayes. Tom has trained people from a large variety of professions, across numerous settings and organizations. This breadth and depth of his experience led him to being recognized as a Peer Reviewed ACT Trainer by the Association for Contextual Behavioral Science. However, his first love has been training behavior analysts in ACT. Tom developed the first series of publicly available work­ shops specifically designed to train Board Certified Behavior Analysts (BCBAs) in ACT and he continues to provide ACT training, supervision, consultation, and mentorship worldwide. In these contexts, Tom had the opportunity to adopt existing ACT procedures that are freely available within the expansive contextual behavioral science community, adapt them for use with behavior analysts, develop new ones, evolve them all to fit into ABA contexts, and most importantly, develop a framework for customizing and creating entirely new ACT procedures with each ABA client, parent, or staff member, in each unique session and moment. This may

Forewordix

sound like a task of impossible complexity, but this book provides the framework for practitio­ ners to carry this out in a digestible manner. Functional analysis—that is, an understanding of human behavior in terms of behaviorenvironment functional relations—has been said to be the heart and soul of behavior analysis. Although ACT has always been a fundamentally functional analytic approach to behavior change, practical procedures for assessing the function of behavior have been missing from the ACT inside ABA tool kit. Until now. Dr. Thomas Szabo has led a team of colleagues and mentees in developing a procedure for brief ACT functional analysis inside ABA for about four years now, including both research and practice, and the data have been promising. As this book goes to press, several data-based manuscripts are undergoing review in peer-reviewed jour­ nals. This book presents practical guidance for ABA clinicians on how to implement the brief ACT functional analysis for the first time. A foreword for this book would not be complete without mentioning compassion. The field of ABA is currently experiencing something of a compassion revolution, or at least evolution. Practitioners everywhere yearn for deeper connection with the human beings they serve. Behavior analysts are taking a stand for putting kindness, human connection, and human dignity before science and data. The approach that this book offers allows us to have both. The perspective from which this book offers ACT training emphasizes serving other humans with respect, love, and humility, while also grounding our procedures in the hard science of behav­ ioral principles of learning and motivation. In short, this book heeds our call to practice with love and science at the same time. Why this book and why now? The field of ABA is at a turning point. BCBAs have expressed a desire to learn more about ACT and enrich their ABA practice with ACT. Many dozens of books on ACT written for mental health practitioners are available and can be tremendously useful. Several ACT curricula for BCBAs have been published and are invaluable resources. But what has not been available, until now, is a manual that helps ABA practitioners, ourselves, develop ACT training skills that can then be applied across clients, behaviors, and curricula. This is that book. This book, implemented with practice across a variety of clients and circum­ stances, and when combined with training and mentorship, has the power to transform the daily practice of behavior analysts. The tools contained within this book can add greater meaning and purpose to what we do, help us connect with our clients on a deeper level, and empower us and our clients to let go of unhelpful struggles with private events and get into the work of ACTing toward our values. Implementing ACT inside ABA presents the field of ABA with a challenge and an oppor­ tunity that may be unique in the history of our field. History will be the judge, but it seems possible that adoption of ACT will be remembered as a major inflection point in the develop­ ment of the field of ABA, toward greater compassion and flexibility, greater effectiveness with clients with complex verbal repertoires, greater meaning and purpose experienced by us profes­ sionals and scientists, and greater openness to change and difference. We may look back on adopting ACT as a “behavioral cusp” at the level of the field of ABA, one that, when learned, will have opened our field to a much broader area to be helpful to others and a much greater

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ACT and Applied Behavior Analysis

power to serve. This book is just one piece of this evolution, but it is a critical piece because it has the potential to empower others. This book challenges researchers and practitioners in the field of ABA to not just read about ACT but also to take committed action toward implementing it with ourselves and with the humans we serve, one small but meaningful step at a time. —Jonathan Tarbox, PhD, BCBA-D University of Southern California and FirstSteps for Kids

Introduction

Welcome. If you are an applied behavior analyst, you have likely been trained by professionals committed to a scientific approach to ameliorating socially significant problems in learning and behavior. The strategies and tactics that your mentors taught you are probably based on obser­ vation of actual behavior; experimentation; and assumptions that behavior is lawful and orderly, that the effects of treatment are most useful when they can be replicated by repeating proce­ dures within or between applications, that the outcomes can be explained parsimoniously or without recourse to complex or unseen variables, and that what seems too good to be true should be viewed with healthy skepticism. If these tenets are the basis of your current repertoire, you are among friends here. This is the applied behavior analysis (ABA) that I came into and practice today. At the same time, ABA is in the midst of rapid, unparalleled change. We are in the throes of a cultural paradigm shift brought on by the pandemic; the neurodiversity movement; unprec­ edented practitioner demand for cultural humility, diversity, equity, and inclusion in our institu­ tions; and a groundswell of interest in compassion as it relates to parents, workers, teachers, and service recipients. Perhaps all of this has been in the works for some time, but it is coming into heightened and sustained focus as this book enters its final prepublication phase. I truly hope these matters will be the stuff of constructive conversations and structural shifts in our field. To that end, acceptance and commitment therapy (ACT), used judiciously by practitioners sensi­ tive to the differences between ABA and talk therapy applications, may be an aid to the field as we attempt to respond to these challenges. I began using ACT in ABA over a decade ago and have trained thousands of behavior analysts over the years. Interest within the ABA community in ACT has been riding a wave I never imagined would swell in this manner when I first began using it and teaching it during my graduate school years—and the wave has not yet crested. To help the ABA community ride this wave, my research lab and I have developed and tested a series of strategies detailed in this book. The assessment strategies described in this volume range from indirect and descriptive ACT functional assessment to brief ACT experimental functional analysis, all within the context of direct contingency functional behavior assessment and analysis. Intervention strate­ gies include detailed instruction on the way to capture subtle figurative uses of language that clients employ, a task analysis for using metaphors to create powerful ACT exercises in the moment with your clients, and ways to build imaginative group exercises scalable to the needs of those with different abilities.

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ACT and Applied Behavior Analysis

How to Use This Book Depending on where you are currently in your ACT training voyage, you may open to any part of this volume or read it straight through from beginning to end. There is no right way to use this manual or order in which to learn the skills. Most people will likely benefit from reading, completing the included exercises, and finding someone with whom to practice from time to time. Repeated practice is more important than the order in which you learn the component repertoires. There are many components, and after mastering any two of them, it would be wise to practice them together as a composite repertoire. Adding components systematically will be easiest if you continue to periodically practice mastered targets in broader contexts that require increasingly complex composite skills. Many beginners are pleased when they hear about a vibrant ACT metaphor or find a ser­ viceable worksheet that they can use as-is with clients. This is a great way to begin, and if you do not have access to training materials such as those found in this book, it is a solid way to try using ACT and observing how ACT exercises help others. But using premade materials, meta­ phors, and activities is not a sustainable way to practice ACT over time. Comprehensive protocols, too, are often sought by beginners. Protocols are important— researchers need them to investigate certain kinds of empirical questions. But the tools used in research are not always helpful in applied practice. In clinical work, ABA involves the design of idiosyncratic interventions that meet the needs of individuals with their own unique learning issues. Developing metaphors based on the client’s use of language in session and activities based on the interests of the client is the substance of skilled ACT practice. Alertness to changes in client behavior during your work together and the capacity to mold instruction to distinctive features of a client’s repeated patterns of behavior is flexibility in context; it is model­ ing the very behavior you aim to evoke. In contrast, lockstep adherence to protocol and the use of prepackaged materials sends a message that the therapist is unwilling to suffer the discomfort of trying out novel behavior in front of a client. It is unsurprising that in this context, clients derive that making bold new moves is too hard, too stressful. Moreover, ABA practitioners learning to use ACT are not generally meeting clients once a week for the fifty-minute hour that is characteristic of most ongoing talk therapy relation­ ships. ABA sessions are often several hours per day and possibly several days per week. In my current practice, I meet with certain parents several times a week for family guidance and their children with special needs a few additional times each week. To rely on the same short list of exercises and metaphors over and over again would be boring for everyone—certainly the client would get bored, and so would I. The antidote, learning to catch metaphors in flight and throw them back in an ongoing game of ball toss, is exhilarating. It is a game in which the rules change as you play. Of course, it is a bit scary. You might not catch the ball. You might throw it over the client’s head. Fortunately, the balls you are throwing are verbal and you can always toss out another one of a different texture, color, temperature, or weight. This book is about learn­ ing to play catch, so to speak, with your clients.

Introduction3

To teach you how to play this kind of game, in this book’s Free Tools page at http://www .newharbinger.com/45816, you will find a series of practical exercises for learning to rapidly identify verbal behaviors that impede the control that contingencies of reinforcement exert upon overt performance. You will also find practices for learning to design unique interventions that you craft with your client, in the moment. Many of the chapters include competencies and examples for you to use to gauge the areas you can learn on your own and those for which you need additional consultation and supervision. All the chapters include multiple examples rele­ vant to the kinds of issues that most ABA practitioners encounter each day. Chapter 1 provides an overview of ACT in ABA, a working description and illustration of ACT used in an ABA context, and primers on the philosophy of science, research, and basic science that undergird ACT. Chapter 2 provides both lay and scientific ways of parsing the six repertoires that ACT suggests comprise psychological flexibility, the aim of ACT in practice. Chapter 3 details the approaches we have developed for indirect, descriptive, and experimental ACT functional assessment and analysis. This chapter includes exercises to help you develop your skills in this area. Chapter 4 provides an outline of one way that ACT assessment and intervention can be staged and evaluated. In chapter 5, the ACT matrix is introduced as a powerhouse behavior analytic ACT tool that can be helpful during both assessment and inter­ vention work. Chapter 6 addresses the issue of how to evoke and capture clinically useful meta­ phor in client speech. Chapter 7 is an introduction to the use of engaging physical exercises that clients will remember and practice on their own to harness the long-term benefits of ACT. Chapters 8 through 13 cover the six ACT repertoires that comprise psychological flexibility. These chapters include competencies and exercises that will help you evaluate your current repertoire and need for further training. The competencies included herein are adapted from Luoma, Hayes, and Walser (2017), Learning ACT: An Acceptance and Commitment Therapy Skills Training Manual for Therapists. I owe Jason Luoma, Steve Hayes, and Robyn Walser a huge debt of gratitude for the work they put into developing this list of competencies. Chapter 14 covers the issues of scope of practice and scope of competence—all behavior analysts using this manual ought to read this chapter! A final section on what to do to continue your training after reading and completing the exercises in this book ends the volume. As a final word of introduction, it is important to mention that you can practice ACT with others without first practicing ACT in your own life—but it will not likely go very well. I say this from experience. During my final years in graduate school, I became deeply enmeshed in a thought that I believed and repeated to myself often. I thought that I was an imposter. I thought I was about to be discovered as a fraud. If you are at all like me, and I suspect you are, then you have had those thoughts, too. I dealt with the pain very poorly. I acted as though I was not thinking this way; I hid from the thoughts and I hid them from my friends and colleagues. I continued to teach others about ACT, but I did not use ACT in my own life in any meaningful way. As a result, what Skinner (1974) called my “world within the skin” became an echo chamber for my thoughts in the presence of which I engaged in many self-destructive behaviors. I made repeated fruitless attempts at taking my own life, each increasingly more severe. I might

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ACT and Applied Behavior Analysis

have succeeded in ending my life had it not been for the help of my father and a few close friends. Things did not get better until I dropped the façade and started using ACT practices in my own life. I learned to embrace these thoughts and the emotions that came alongside them as though they were old friends that had once taught me ways to cope that were adequate in the past but no longer helpful. I began the practice of returning my focus from the future I feared to the present I could experience and observing my impressions of myself rather than managing others’ impressions of me. I learned to ongoingly remind myself that what I was up to was bigger than me alone, and that if I could help just one person, then being honest and sharing what I was going through would be worth it. I learned to tremble and walk and stumble and fall and get up with my friends by my side, instead of trying to do it all by myself. This book is a vessel filled with these spirits of community, openness, and action. I hope that you will take a few sips from this chalice and see for yourself whether there is something here for you. And then I hope that you will share what you find here with others, if and when doing so may be of service to them.

CHAPTER 1

ACT in ABA, the Research That Got Us Here, and an RFT Primer

ACT in ABA During the last two decades, children with autism and related special needs have been the most widely recognized recipients of ABA services. Due to successful public awareness campaigns and changes in physician training programs, children with autism and other intellectual and developmental differences are now being referred to ABA treatment very early in their lives. As a result, the work ABA practitioners do can rapidly shift from early intensive behavioral inter­ vention (EIBI) to academic, vocational, and social skills training. Practitioners today are often teaching skills that are at the high end or beyond the scope of VB-MAPP and ABLLS curri­ cula. Clinics using the PEAK Relational Training System frequently advance learners to the higher-level targets within just a few years of service. For example, it is not uncommon to find children with autism under the age of nine who master receptive and expressive metonymical tact programs that call for pointing to or naming stimuli with uncommon names or programs that require inferences about others’ thinking, based on observable contextual cues. But these advances come with a price tag. When at the higher end of such educational programs, children are arriving to sessions saying, “I can see it now. They’re not laughing with me. They’re laughing at me.” Older autistic people wrestle with making friends, maintaining them, forming, keeping, and ending romantic relationships, experiencing healthy and fulfilling sexual partnerships, and so on. Parents struggle, too. During training sessions, parents and extended caregivers may lack focus as they try to decompress after the latest insult from a school administrator or the difficult commute to and from a dozen important doctors’ offices. RBTs and BCaBAs also suffer. Burnout is common among these workers who are struck repeat­ edly by clients, dismissed by parents, and rebuked by teachers in the schools. In all, the practice of ABA is due for a fresh look at some of the ways we address emotional challenges. It is in this context that acceptance and commitment training (referred to in this volume as ACT) can serve children, parents, teachers, and ABA practitioners.

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ACT and Applied Behavior Analysis

What Is ACT? At its core, ACT is a way of helping people respond to difficult life events with a kind of flexibil­ ity that is unavailable to nonverbal organisms. When direct contingencies would evoke nonop­ timal behavior, this kind of flexibility, one that involves verbally relating events in increasingly abstracted dimensions, bestows remarkable advantages upon those who use it. Consider the suffering of Amélie, a young, single mother of two children with autism, one of whom is significantly affected. Outwardly, Amélie seems to be managing gracefully—she is the manager of a high-end retail concern, she is a homeowner in an upwardly mobile commu­ nity, and she communicates regularly with other parents of autistic children receiving ABA services. She has a hardy laugh and a witty sense of humor. To others, she seems a pillar of strength. But in the mornings when she gets out of bed, Amélie weeps. She has been unable to follow many of the behavior program recommendations she has been given, even after extensive prac­ tice and reinforcement. Amélie cannot say why this is so, and she cannot admit her inaction to anyone. But it is certainly clear to her ABA workers because they observe the contrast between Amélie’s kids’ contented behavior when they are with the RBTs and the agitation they display when they are with their mom. In an ACT-based parent guidance session, Amélie tears up and says that upon rising each day, she asks, “Why me?” She reports, “Then I get up and put on a happy face to push through my tears.” Donning a happy face is not real for her, and it is as though, in pushing away her pain, she is pushing away a tender and important part of her most deeply felt experience. During a brief coaching session, she physicalizes this defensive posture and acknowledges that it is a strategy that fails her in the end because when her fists are raised to protect her, they can do nothing else. She confides that she is spending a lot of time yelling at her kids rather than instructing, reinforcing, and playing with them. Then, Amélie tries something new, something bold. She opens her fists and widens her arms as if to welcome in her experience. Amélie says of herself that she is a tough person and that she is disinterested in meditation and other New Age “fantasies.” Yet she is willing to try practicing this odd opening posture and welcoming her difficult emotions briefly each day when it comes time to use differential reinforcement and other ABA strategies with her kids. After a few weeks of practice followed by some backsliding and regrouping, Amélie finds her stride. She notes that the practice of physically opening to her experience and choosing her life as opposed to fighting it is making it possible to do hard things at difficult times. The effect upon her two kids is noticeable after a few weeks. There is much work still to be done, but the first steps are now behind her. To Amélie, the most remarkable thing is that when telling other parents with whom she talks of her hidden shame, paralysis, and missteps, they do not see her as weak. Instead, they seem to treasure her vulnerability, a side of her they had not seen before. Amélie’s experience of ACT in ABA is not uncommon. It involves simple exercises prac­ ticed and reinforced frequently alongside other observable, measurable behavior. The exercises generate behavioral momentum that reduces inertia for engaging in more difficult ABA tasks. Further, these exercises help reorient her away from nonoptimal behavior that produces smaller

ACT in ABA, the Research That Got Us Here, and an RFT Primer7

reinforcers available immediately and toward desirable behaviors that in the long run yield larger reinforcers. The outcome is being able to persist or change as the context demands, even when doing so is difficult in the moment. Because it is a network of interrelated skills, the devel­ opers of ACT refer to this outcome as psychological flexibility. But ACT is even more than this. ACT is also a way of helping people do what B. F. Skinner said it was culture’s job to help people do: orient toward a future that has not yet happened. This is a distinction that is vitally important. Radical behaviorism hinges on the notion that covert behavior is, in principle, no different than other behavior. Like any behavior, covert responding is the product of anteced­ ents and consequences found in the external environment. These behaviors do not cause overt behavior; they are simply more behavior to be explained. But if all behavior is the result of pushpull direct-acting contingencies of reinforcement, there is little need for any analysis of private behavior. We should simply look at overt behaviors, identify those that are successful and unsuccessful, and manipulate the contingencies of reinforcement that maintain them accord­ ingly. However, in Amélie’s case, differential reinforcement was well instructed and reinforced to mastery. Her inaction was not a learning deficit. It was a performance matter that was occur­ ring in contexts where the ABA practitioners who instructed her could not be present to rein­ force desired behavior. Moreover, it would be very difficult to explain how a response emitted today that is effortful and does not contact reinforcement until much later could be emitted under the control of reinforcement as demonstrated in the operant pigeon and rat labs. Amélie’s behavior of opening her arms to the experience of her child’s tantrum when she uses differential reinforcement would indeed be difficult to explain, since in the moment, this behavior is met with aversive behavior by her child. The reinforcement for Amélie is weeks, even months away. Something other than direct contingencies of reinforcement must be at work. But to analyze Amélie’s suc­ cessful persistence by appealing to her determination, her stamina, or some other trait variable would be to invoke an explanatory fiction. Instead, the behavior analytic solution is to view the stimulus products of covert behavior as stimuli that may have motivative, discriminative, rein­ forcing, or punishing effects. For example, after thinking, “I choose to love fully and behave contingently with my children, even when it hurts to do so,” the product of that thinking is a repeatable statement that is now a stimulus, a manipulable part of the environment. In short, radical behaviorism holds together only so long as we consider overt and covert behavior as both important and co-occurring. Thus, there are two threats to radical behavior­ ism that must be guarded against. On the one hand, positing that covert behavior causes overt performance, and on the other, saying that only what is observable matters, are both rejections of radical behaviorism that threaten this philosophical system at its core. In contrast, a radical behavioral view is that we can orient toward a verbal future that has not yet occurred when private stimuli, the products of private verbal behavior, influence our overt behavior. They supplement putative environmental variables that more directly control behavior. Covert stimuli do not exert the same kind of control that overt variables do, and they are rather diffi­ cult, if not impossible to measure in a precise way. The control exerted is more flexible, at times

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less and at other times more powerful than directly manipulable events. For this reason, it is more useful to talk about prediction and influence as the outcomes of behavior analytic work with humans capable of verbal reasoning, as opposed to prediction and control. Such a shift maintains the integrity of radical behaviorism while offering a useful clarifying distinction.

Radical Behaviorism and Functional Contextualism ACT was developed within the behavior analytic tradition, so at its center, you might say that ACT is a radical behaviorist framework for approaching human suffering in a verbal context. But from the beginning, Steven C. Hayes, Marsha Linehan, Mavis Tsai, Bob Kohlenberg, and others involved in developing new behavioral approaches were interested in bringing together the many seemingly unrelated psychological traditions. If learning theory grounded in evolu­ tionary science was correct, all the disparate psychological approaches could be sifted through to find common behavioral processes that were consistently linked to desired outcomes. The aim of evolving one psychology seemed important, but far away. Yet Hayne Reese, one of Hayes’s graduate school professors, handed Hayes a copy of Pepper’s World Hypotheses. In this book, Pepper distills the myriad well-known philosophies of science into four classes: formist, organi­ cist, mechanist, and contextualist worldviews. Behavior analysts are taught basic tenets of radical behaviorism and told that this is their field’s philosophy of science. But most behavior analysts are not offered training in philosophy of science as a discipline, more broadly. It is different from a personal philosophy or a political one. Philosophy of science involves the examination of pre-analytic beliefs regarding the acqui­ sition of scientific knowledge. These are the assumptions with which you begin your work as a science-informed practitioner. They are the assumptions you walk in the door with. Usually, you don’t even know they are there. They are like a pair of glasses on your face: they focus your vision a particular way, but you don’t often think about their effect on what you see until you try looking at things without them. They can change and you can change them, but to do so you have to first learn to see them. For example, does the universe consist of a series of universal ideal forms of which all existing things are knockoffs? Drilling it down further, is there an ideal applied behavior analytic approach to tackling self-injurious behavior (SIB) in the child with low-functioning autism? Or is the behavior analytic approach to this problem akin to a machine with parts that can be disassembled and reassembled? When you start from that position, you find the part that isn’t working, repair or replace it, and fix the child as you would a machine. Or perhaps you subscribe to another distinct and commonly held view: that the child with autism is going to be who he is and the autism worker is going to be who he is and their interac­ tion is the only interaction that can be given who they both are, and ours is merely to provide water and soil to this interactive tree of life. In contrast, is the behavioral approach one in which what “is” exists only in the context of a set of goals—thus, the best treatment for SIB is a highly individualized, functional intervention that meets the specific needs of a particular child in a special context? Each of these four assumptions is common, fundamentally distinct,

ACT in ABA, the Research That Got Us Here, and an RFT Primer9

and leads to a completely different way of addressing problems in science and practice. Studying philosophy of science is about owning your professional assumptions, the implicit assumptions of your discipline. Pepper’s book brought clarity to the differences between these four clusters of scientific philosophies. Formism, Pepper claimed, is the dominant view of philosophies that begin with the assumption that there are ideal forms—ideal ways of being and ideal ways of treating prob­ lems. Some early scientific philosophies, particularly those under the control of powerful theis­ tic agencies, maintained formist world views. In The Republic, Plato suggests a psychological treatise that exemplifies the essentialist stance of formism in which citizens are born as gold, silver, brass, or iron. Because they are born in these ways, some are fit to rule and others to labor. From the standpoint of a formist philosophy of science, there would be no point to teach­ ing a child born with a severe disability, because their disability is their essence. Mechanism is the prevailing stance of scientific philosophies that assume problems, and for that matter, people, are the sum of their parts. If there are problems, you disassemble the parts, find the faulty ones, and replace them with parts that work. Mechanistic psychologies assume that human suffering can be taxonomized into hundreds of signs, symptoms, syndromes, and disor­ ders, each of which can be linked to biological markers for which there are unique, individual treatment types. For over fifty years, psychiatry has held to this model. Organicism is the posi­ tion that all things develop within an ecosystem, thus, they can only become what the ecosys­ tem supports. As an acorn can only become an oak tree, a person with autism can learn many things, but will always be an autistic person. Contextualism is the position that things in the universe are the product of their immediate and historical environs. Contextualist psychology is interested in behavior situated in its spectra of remote and proximate contexts. Radical behaviorism, unlike the methodological, mechanistic behaviorism of John Watson, is a prime example of contextualism. It was several years before Hayes read the book Reese handed him, but when he did, Hayes found this approach useful toward the aim of bringing together the many disparate psycholo­ gies. Hayes posited that if it is the case that there are many contextualistic philosophies of science, then perhaps they can be united in the search for common processes of change along the lines of this philosophical position. For example, functional analytic psychotherapy (FAP; Kohlenberg & Tsai, 1994) is a Skinnerian radical behavioral treatment modality that begins with the assumption that people are social organisms and that by beginning with their interac­ tion in session, they can be taught to look inward. ACT begins with the assumption that people relate verbally in a private way and that by first undermining unworkable patterns of verbal behavior a person can be taught to see themselves and subsequently others in new ways. One begins socially and turns inward later; the other begins inwardly and subsequently turns toward the social. Although these two treatment modalities begin with different assumptions, they share a common stance that behavior is primarily a function of its context, whether verbal, social, or otherwise. Viewing contextualism as the underlying scaffold that holds these diver­ gent treatments together makes it possible for FAP and ACT practitioners to communicate as partners within a common tradition.

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ACT and Applied Behavior Analysis

Thus, from a contextualist vantage, there is no one true way of conceptualizing a problem or a solution; rather, truth is found in what works, given a unique set of influences at a given time. One has only to look to see the many different special interest groups of the Association for Contextual Behavior Science to see that this re-envisioning of radical behaviorism as part of a broad network of pragmatic, contextualist philosophies of science has paid off; there is a consilience that is bringing new thought to behaviorism and new behaviorist sensibilities to older traditions. This convergence is not a hodgepodge of assimilations. Rather, it is the emer­ gence of a framework for interpreting the results of decades of scientific psychology research from various traditions, a frame that has been wrought over the fires of meta-analyses, withinsubject investigations, and randomized control trials (depending on the question being asked). Although other contextualist frameworks have been suggested, Hayes (1993) proposed that ACT and behavior analysis sit within a branch of pragmatic orientations that could be termed functional contextualism for their direct ascendence from the functionalist emphases of the American pragmatist philosophical tradition characterized by William James (1890) and John Dewey (1908), among others. This rather recent history could easily obscure the decades of human operant research that led to ACT and the theory of language and cognition known as relational frame theory (RFT). For behavior analysts, it is useful to be aware of the research on human behavior that led to RFT and ACT. In fact, that research began with curious findings that perplexed investigators in the 1970s and ’80s.

The Research That Got Us Here In its early years, the pages of the Journal of Applied Behavior Analysis were filled with ventures into community psychology. These were heady days. The earliest aspirations in the field were to fulfill Skinner’s promise to save the world with behavior analysis. Some envisioned that our field would start in on some difficult social problems and move toward solving bigger and more vexing issues later. Strategies for helping typically developing teens with delinquent behavior, procedures for improving decision-making among community board members in disadvantaged neighborhoods, and practices for producing deep muscle relaxation were among the first notable studies in our flagship applied journal. Even before that, papers on nurse training for interven­ ing in challenging behavior in psychiatric wards, reading instruction, and college education in the context of competing contingencies were shaping the field. But within these early studies you could also sense the pull toward a program of research that would focus on the behavior of people with learning needs that were unusual and challeng­ ing. This is understandable. If you could pinpoint impediments to advanced learning in those with severe challenges, you could in theory use similar strategies to assist others in mainstream environments. It was a gambit in the vein of Tom Gilbert’s (1978) advice to those working in

ACT in ABA, the Research That Got Us Here, and an RFT Primer11

organizations: if you are looking to secure the trust of decision-makers, do not set out to improve the work of those whose performance is already close to criterion. Instead, Gilbert suggested, tackle the performances with the greatest potential for improvement. Accordingly, early ABA studies moved away from community psychology to helping those with the most challenging learning deficits and behavioral excesses: people with intellectual and developmental disabilities. The behavior of those with the most profound and pervasive disabilities was eventually found to reliably come under the control of social positive, social negative, auto positive, and auto negative contingencies of reinforcement. But in 1971, Sidman reported an unexpected finding. He had been using a conditional discrimination procedure to teach learners with severe intellectual disabilities and the barest of identifiable verbal skills to develop basic reading reper­ toires. That is, he taught learners offered an array of pictures to point to one in particular when a given word was spoken and to form the words vocally. Interestingly, the latter occurred without direct training or reinforcement. Then he taught the same students to select the cor­ responding written word from an array of printed words, and again without formal training or reinforcement, the students learned to say the word when shown the printed version. Bidirectional responses in the absence of direct training and reinforcement were startling in themselves, but what most captured Sidman’s attention was the fact that these learners could then point to the written word when shown a picture and a picture when shown a written word. This again was remarkable and unforeseen in the operant literature. Based on mathematical set theory, Sidman referred to the untrained learning as derived symmetrical and transitive verbal relations and the overarching effect as stimulus equivalence. The finding spawned decades of early research into the way that verbal behavior instruction can be arranged for those with intellectual challenges. To understand the enormity of this finding, consider what you learned in school about the basic procedures in respondent and operant conditioning. In respondent conditioning, a neutral stimulus (NS) that does not produce an unconditioned response (UR) is correlated with an unconditioned stimulus (US) that reliably elicits the UR. After repeated correlations, the NS now elicits the UR; thus, it functions as a conditioned stimulus (CS) and the response it elicits is now referred to as a conditioned response (CR). Operant conditioning involves discrimina­ tion training wherein an NS+ preceding a response that produces a reinforcer and an NS- pre­ ceding a response that does not produce the reinforcer change in function to being discriminative (SD) and extinction stimuli (S∆), respectively. Operant conditioning also involves the correla­ tion of an NS with an unconditioned reinforcer (SR+) such that the presentation of the NS without the SR+ will increase the future selection of the response that produces it. This NS now functions as a conditioned reinforcer (Sr+). In each case, as can be seen in figure 1.1, condition­ ing occurs in one direction.

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ACT and Applied Behavior Analysis

Figure 1.1 That these conditionings in respondent and operant procedures occur in one direction is no small matter. In the respondent case, imagine that you are walking in the woods and you smell a pungent odor. It is a strong smell, but it does not stop you from walking forward—until a bear leaps out from behind a boulder and roars at you. In the future, when you smell the pungent odor, you startle. The odor has become a CS. How odd would it be were you to return to your home in the city and, upon startling at a loud unusual noise, you began sniffing around for the smell of a bear. Respondent conditioning is unidirectional. In the operant discrimina­ tion case, imagine you have learned that when your mom is in the kitchen and you mand for food, food is presented. It would be strange if later on when your mother was at work, you opened a cupboard to find food and then looked around to see where your mother is. Operant reinforcement examples are equally amusing. You learned that when it is raining outside, grab­ bing an umbrella produces a smile from your mom. One afternoon you are seated at the dining room table and your mother smiles at you. Would you then grab an umbrella to make sure your mother had sufficient reason to smile at you? Operant procedures result in unidirectional conditioning. Sidman’s finding that human verbal learning involves the acquisition of inverse and com­ bined relations that are untrained and that can be demonstrated with stimuli bearing no formal or topographical similarity was exciting. But an equally important finding emerged from a number of camps investigating the insensitivity of rule-governed behavior to prevalent sched­ ules of reinforcement. It had long been noted that human performance on classic schedules of reinforcement differed from that of nonhuman animals, but there were differing accounts as to why these patterns were observed. One account (Lowe, Harzem, & Hughes, 1978) surmised that interference from self-instructions produced divergences from the classic response patterns found on typical schedules. When adults were placed on a fixed interval (FI) schedule, attenu­ ating this interference resulted in reinstating the usual FI scallop. This led to the prediction that if human verbal behavior is responsible for the difference between human and nonhuman schedule performance, then humans without verbal skills should perform as do other animals. In an early study aimed at parsing this phenomenon, Lowe, Beasty, and Bentall (1983) demon­ strated that human infants under the age of one performed indistinguishably from nonhumans,

ACT in ABA, the Research That Got Us Here, and an RFT Primer13

thus lending support to the notion that verbal behavior can serve a discriminative function that alters the effects of other variables such as scheduled reinforcement. Concurrent with this emerging line of inquiry, a number of teams investigated the condi­ tions under which rule-governed behavior will be sensitive to consequences and when it will show schedule insensitivity. Matthews, Shimoff, Catania, and Sagvolden (1977) yoked contin­ gencies for key pressing in college student dyads and found that instructed performance was insensitive to the difference between ratio and interval contingencies, whereas shaped respond­ ing showed sensitivity. Shimoff, Catania, and Mathews (1981) demonstrated that college student schedule performance was impeded when they were given instructions compared to when they were not. Hayes, Brownstein, Haas, and Greenway (1986) provided differential instructions (press fast, press slow, and press fast or slow to earn money) to college students in a human operant preparation with multiple schedule and subsequent extinction schedules. The instruc­ tions were either minimal, partially accurate, or totally accurate. Those given minimal instruc­ tions performed comparably to those given accurate rules. But during extinction, only those who were given minimal instructions demonstrated sensitivity to the change in contingencies. Thus, successful performance under the control of rules appears to be only pseudo-sensitive to the contingencies, whereas behavior shaped by the contingencies is nimbly responsive to shifts in the relative and overall rates of reinforcement. Taken together, equivalence, naming, and schedule insensitivity findings paved the way to new interpretations of operant verbal behavior. For some, at issue was Skinner’s 1957 definition of verbal behavior. Skinner proposed that verbal behavior is the performance of a speaker rein­ forced by a verbal community specially trained to provide this reinforcement. By Skinner’s account, a learner emits verbal behavior when it is reliably reinforced by others with verbal repertoires. This would explain a child learning to speak and read in the presence of family and teachers who condition these behaviors with training and reinforcement. But as noted above, a great deal of verbal learning occurs without training and reinforcement. Sidman (1982) sug­ gested that stimulus equivalence was a linguistic prerequisite to verbal behavior; thereby, he refrained from inferring that there were any problems in Skinner’s definition of verbal behavior. But others have noted many problems to address. First, Skinner’s omission of equivalence weakens the distinction he offered between contingency-shaped and rule-governed behavior. A learner displaying equivalence at age two may cease demonstrating schedule sensitivity despite being as yet unable to reliably exhibit mands, tacts, or echoics. Another learner may be given an accurate rule and specified consequences, yet still exhibit nonoptimal behavior. Second, Skinner’s definition is too broad. Behavior reinforced through the mediation of other persons in accordance with the practices of the verbal community leaves open the pos­ sibility that nonhumans can engage in verbal behavior. In theory, there is nothing objectionable here. After all, Epstein, Lanza, and Skinner (1980) trained two pigeons, Jack and Jill, to mand, listen, respond, and reinforce each other’s verbal behavior in an operant chamber designed to simulate the conditions under which humans engage in complex behaviors often referred to as

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symbolic communication. In further demonstrations, Epstein et al. trained pigeons to engage in what is commonly called self-awareness; that is, they learned to use a mirror to locate an object on their bodies that they could not see directly. In The Behavior of Organisms, Skinner (1938) suggested that across species, behavior conforms to schedules and principles of behavior, but human verbal behavior is a notable exception. Yet the definition Skinner advanced in 1957 seems a reversal of this statement, and the demonstrations he published with Epstein (1980) suggest he no longer held that human verbal behavior is distinct from that of nonhumans. These demonstrations are consistent with the continuity strategy—an empirical approach to investigating basic principles of learning across species. They have been useful in demon­ strating the utility of using pigeons to study people. What has been attributed to human mental processes can be demonstrated in organisms lacking the cerebrum said to facilitate mental processes. But there are limits to this strategy. Here is an experiment I conducted with my dog to illustrate the inherent limitations in Skinner’s definition of verbal behavior. After a period of time in the house, my dog Cimba goes to the door and barks. I go to the door, open it, and my dog exits. After an hour, Cimba returns to the door, barks again, I open the door, and she comes inside the house. By Skinner’s definition, Cimba has engaged in verbal behavior and I, as a verbal community specially trained to reinforce the behavior, served a listener function. Later, after learning from my girlfriend that she is breaking up with me, I sit on the couch and weep loudly. Upon hearing my cries, Cimba leaps to the couch and begins licking my face. She seems to engage in an empathetic response, and her ministrations do make me feel better. But of course, in the past when she has heard me weep, she has licked my face and been rein­ forced with the taste of salty tears. It is not that she cannot feel empathy, but it would be men­ talistic to say that in this case she is empathetic. We cannot know for certain, even if it is possible or even likely that she is feeling empathy. An hour later, I invite Cimba to sit with me on the couch again and with calm resolve (that is, with no emotional inflections in my voice or tears on my face) I tell Cimba that even though she loves my former girlfriend, she is leaving and it is for real this time. I tell her earnestly, and what does she do? Cimba rolls onto her back and falls asleep. I wake her and tell her that I am serious, but she rolls over and snores. It would be possible to train Cimba to respond emotionally to specific words, such as “leaving” or “real.” But were I to then change the words and instead say “going away” and “final,” once again, Cimba would again display no sign of empathy. Whereas others would ask me why, offer to stay awake with me, ask me to go with them to see a movie or to grab a drink and talk about it, Cimba closes her eyes and naps. What Cimba lacks is an ability to listen with understanding and speak with meaning. How such a repertoire emerges has been the topic of many theoretical and empirical strategies, such as naming, equivalence, and stimulus control topography coherence. But the approach that has generated the broadest body of well-controlled research from the largest number of investigative teams around the globe is relational frame theory (RFT). We turn now to a brief tutorial on the basic findings of RFT.

ACT in ABA, the Research That Got Us Here, and an RFT Primer15

Relational Frame Theory RFT suggests that a better definition of verbal behavior is relating stimuli arbitrarily. Humans and nonhumans alike learn to respond to conventional stimuli, such as words and symbols. But when humans are repeatedly reinforced for relating stimuli that share no formal properties in accordance with numerous cues that are equally conventional (equal to, more than, less than, opposite to, part of, etc.), they begin to emit these responses in novel contexts using equally novel response forms independent of social cues and reinforcers. Importantly, verbal stimuli with one characteristic function newly related to other verbal stimuli with another function change in function such that the relations cohere. In many cases, overt behavior follows. A brief example may help to illustrate. Having contacted reinforcement over nearly my entire life for eating pizza, chicken, and beef, I had a well-entrenched repertoire of eating animal products. A few years ago, someone who had worked in the industry told me a series of stories about the conditions under which dairy, poultry, and beef animals are raised and slaughtered. Subsequently, I read scholarly accounts in scientific journals of the way that Amazon fires were devastating the rainforests to make way for agribusiness. I read further that the loss of global vegetation due to the widespread burning of rainforests to make room for agribusiness can cause global climate changes that make the world less habitable and that result in soil erosion, flooding, and destruction of homelands for indigenous peoples in the Amazon. It was not long before I began to relate eating animal products with causing suffering and producing irreversible harm to the planet. Subsequently, I decided to turn to a plant-based diet and have been eating a vegan diet for several years now. I have never been to an agribusiness farm or a rainforest. I did not look at visual images of farm animals or indigenous peoples and I did not listen to the cries of people or animals. I listened instead to the stories my friend told me about these cries and I read a few scientific papers. This substantially altered the functions of meat and dairy products for me. I then derived that changing my food consumption would be a small, valuesbased action I could take to model a kind of behavior that others could follow too, and I changed my behavior. I had consumed food without thinking about it for over fifty years. I could have examined my eating practices decades ago; after all, I knew vegans since I was in my teens. It seems sad as I look back on this that I did not act sooner. But once the transformation of function of these verbal stimuli occurred, a cascade of new verbal relations emerged, making my previous behavior untenable to me. In this example, the behavior I engaged in is called relational framing. In the past, I actively framed relations between eating animal products and animal farms as desirable and necessary in contrast to a plant-based diet that I framed with vegetable farms as undesirable and avoid­ able. You might say that eating animal products and animal farms versus plant-based diets and vegetable farms were the beams of two independent structures that I had been comparing. The beams of a house are connected with joists, in this case, necessary and desirable versus avoid­ able and undesirable (see figure 1.2).

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Figure 1.2 In RFT terms, these beams are relata, or things being related. The relational cues that govern the way they hold together are like joists. The technical term for them is Crel. The context in which this comparative relation cohered was that of my family, a social environment in which tasty animal-based foods and social interaction reinforced a variety of behaviors important to the group. The technical term for this context is Cfunc. As the transformation of respondent (emotional) stimulus functions and operant discrimi­ native and reinforcing functions of the Crel above began to transform, it is important to note that nothing was lost or subtracted in the process. Meat and dairy are still appetitive to my olfactory and taste systems. However, new functions have been added. The older functions of these verbal stimuli have been placed on extinction, a procedure that reduces behavior but does not eliminate it. This distinction will become important in the chapters that follow. ACT is a form of verbal exposure that operates via verbal extinction. When behavior undergoes extinc­ tion, after the initial burst of previously reinforced behavior, extinction induces response vari­ ability. Thus, ACT is a repertoire-expanding intervention approach in which new behavior that contacts positive reinforcement is occasioned. Another important distinction is the Cfunc that served to buttress earlier relations between the relata described above also did not change. My family continues to eat animal products and I am certain it would be easier for them if I did, too. But the context in which my behavior changed was a much larger Cfunc with even greater appetitive properties. Again, nothing is sub­ tracted when relational framing undergoes transformation of stimulus function; new functions emerge that are larger, and these new Cfunc begin to evoke novel behavior. ACT exercises and metaphors serve in exactly this way—new functional cues serve to shift relational cues that bind verbal stimuli. As a result, new, increasingly successful behavior is occasioned (see figure 1.3).

ACT in ABA, the Research That Got Us Here, and an RFT Primer17

Family (Cfunc)

Figure 1.3

Common Empirically Investigated Relational Frames As you might imagine, equivalence relations are likely the first that are established in language training. These are relations of coordination, defined by common Crel such as same as, similar to, equals, and so on. Other relational frames are distinction (different from, unlike), opposition (the opposite of, diametrically opposed to), spatial (above, under, beside), comparison (stronger/ weaker, more/less), hierarchical (part of/the class of), causal (if/then, cause/effect), and deictic (I/you, here/there, and now/then in any combination). With the exception of deictic relations, each of these are presumed to emerge as arbitrarily applicable derived relational response classes after first being trained using nonarbitrary stimulus relation exemplars. For example, after mul­ tiple exemplars reveal that bigger/smaller denote physical size, one can learn that being nice is bigger than being mean and hoarding toys is smaller than sharing them. Deictic relations are different in that there are no nonarbitrary correlates of the self in time and place. These combined perspectival relations likely emerge after temporal, spatial, coordi­ nation, distinction, and hierarchy relations and they are the topic of much contemporary research into the development of flexible notions of self and other. As Skinner (1953) suggested, a child learns about themself when asked questions such as “What did you do?” “What are you doing now?” and “What will you do?” and learns about their private world when an adult speaks to them about their collateral responses (“You’re laughing! This is funny to you!”), publicly accompanying stimuli (“You’re bleeding! That must hurt!”), common properties (“You are bubbly today just like a soda pop!”), and response reduction (“It’s great that you know how to move the rook and the knight. Now decide on your next move quietly so that I don’t know why you are doing what you are doing, because you are trying to beat me in this game!”). But after

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ACT and Applied Behavior Analysis

these early nonarbitrary lessons, the combined deictic relations of I/here/now in contrast to you/ there/then requires additional training for which only arbitrary exemplars can service the learner (“You are sitting in a blue chair. I am sitting on a red chair. If I were you and you were me, what color chair would you be sitting on? What color chair would I be sitting on?”). This transposition of self in space may have some nonarbitrary components, but because it involves verbal reasoning, it cannot be taught purely with nonarbitrary exemplars.

Bidirectional Relational Terms Owing to their basis in mathematical set theory, the terms used to describe derived bidirec­ tional relations in equivalence research are reflexivity (a physical apple occasions pointing to another such apple), symmetry (a physical apple occasions pointing to a picture of an apple and, without further training, the picture occasions pointing to the physical apple; and simultane­ ously, a physical apple occasions pointing to the written word “a-p-p-l-e,” and, again without training, the written word occasions pointing to the physical apple), and transitivity (after the derived symmetrical relations are learned, seeing the written word occasions pointing to the picture and seeing the picture occasions pointing to the written word—each without additional training or reinforcement). RFT posits that such relations of coordination are only the first, after which relations of distinction, opposition, and so forth can be trained. Thus, mathematical set theory terms are replaced with a more expansive lexicon. Reflexive relations are a given, but symmetrical rela­ tions between nonequivalent types are considered mutually entailed; that is, when one is learned, the inverse is a given. Amadeus is better than Ludwig entails that Ludwig is not as good as Amadeus. The derived relation is not symmetrical; rather, it is entailed. Subsequently, when two related symmetrical relations are combined, the derived relations are combinatorially entailed. Continuing the above example, Ludwig is not as good as Na’Quia; thus, Na’Quia is better than Ludwig is a mutually entailed relation. But what is Na’Quia in relation to Amadeus? Na’Quia is either similar to or equal to Amadeus, though the exact relation cannot be derived. Therefore, this is not a precise transitive relation. Instead, the relative relation is entailed by the facts of the two relations combined. Finally, the term used to describe the way these relations change as the verbal or environ­ mental context changes is transformation of stimulus function. Na’Quia was the first African composer whose musical compositions were played as the main event after short pieces by Mozart and Beethoven were played during a Philharmonic Orchestra event in Europe. Given this new information, perhaps the evaluation of her skill compared to that of these others is no longer meaningful. The entailed and combined relationships between these three composers’ names now have a powerful historical context in which their meanings have changed. Did you notice that your appreciation of the name Na’Quia changed with this last bit of information? If so, its function changed for you. Perhaps no other term used in RFT carries as much weight as transformation of stimulus function. You might say that all of ACT is an effort to

ACT in ABA, the Research That Got Us Here, and an RFT Primer19

produce such function changes in stimulus relations. We will unpack this in subsequent chap­ ters, but for our purposes here, consider this: when you can peer into the most frightening and painful parts of your experience with a sense of curiosity, perhaps from a distance, perhaps in a spirit of playfulness, their functions transform from aversive to appetitive. The aversiveness of these events does not go away, but when curiosity, creative distancing, and play are added, something new is created. What that is varies from moment to moment, but the net effect is that you are free to behave in ways that were constricted when these events were nothing but awful. When so transformed, painful events may become awful and beautiful, terrible and pur­ poseful, unwanted and yet approachable.

 RFT is a basic science account of language and cognition. Like all basic sciences, RFT is advancing. Many new developments in the field are changing the way we think about relational framing. The purpose of discussing RFT in this chapter was to introduce the basic tenets of this approach. A few additional, newer concepts will be introduced in the chapters ahead. But for more in-depth and scholarly treatments of these topics, please consult the Journal of Contextual Behavior Science.

CHAPTER 2

The View from Above: Six Repertoires to Practice Before the Going Gets Tough

Six Processes (a Lay Version of ACT) Most treatments of ACT break the model into six processes linked to improved psychological outcomes. The processes were named using what are called “middle-level terms,” quick-tounderstand expressions that when used can capture the overall theme in an allegro tempo. That is, the ACT processes are not technical terms linked to discrete basic principles. They are rela­ tively adequate terms that rapidly orient the analyst and client to functional relations between behavior and environment. The six processes are named using words that had appeal to people who grew up in a postindustrial Western culture during the mid-twentieth century. Then and now, most people in the West have had some exposure to yoga, meditation, Zen, and twelvestep programs in which coming back to the now, being present, and accepting difficulties rather than fighting against them are frequent themes. Thus, the labels acceptance, cognitive defusion, present moment awareness, self-as-context, values, and committed action were used to describe the six core features of ACT work because they either made sense without any explanation or could be pitched relatively quickly and without recourse to technical descriptions. Before providing behavior analytic terms for these processes, it may be useful to learn how they are typically discussed in the ACT literature.

Acceptance and Experiential Avoidance In lay terms, accepting refers to being willing to experience difficult emotions, memories, and physical sensations. The flip of this is experiential avoidance. It would be easy enough to call this simple escape or avoidance, but in ACT we distinguish avoidance of people, places, and things from avoidance of the emotions, memories, and bodily sensations that are encoun­ tered when approaching these people, places, and things. In other words, escape and avoidance are terms most useful when describing efforts to manage contact with aversive physical events. In contrast, experiential avoidance refers to efforts to avoid or escape the psychological functions of those events. In a similar way, we might think of approach as physical behavior with respect

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ACT and Applied Behavior Analysis

to people, places, and things, and acceptance as verbal approach toward the psychological func­ tions of these same people, places, and things. B. F. Skinner seemed ready to acknowledge the kind of avoidance we term experiential. In Science and Human Behavior (1953), Skinner wrote: A problem of great military importance is the behavior of avoiding battle. Malingering, desertion, or a “nervous breakdown” may reach a very high probability. Successful preparation of the fighting man requires a clear understanding of the effect of the stimuli which precede the more aversive stimuli of combat. The man may be avoiding, not merely battle, but his own reactions of anxiety. (pp. 179–180) Before writing these words, Skinner had conducted some thirty years of investigation in the laboratory with pigeons and rats. What he wrote in Science and Human Behavior was an inter­ pretation of the data obtained as they might be seen in humans. Human operant data on expe­ riential avoidance had not yet been amassed; thus, these words amounted to a call for further research. Fortunately, a large part of that research has been conducted or is underway in RFT and ACT labs across the globe. But it is important to note that Skinner had anticipated expe­ riential avoidance and suggested it throughout his work in later years.

Cognitive Defusion and Fusion Cognitive defusion involves observing your thoughts without being ruled by them, or seeing your thoughts as thoughts, rather than as requirements for action. The flip side of this is fusion, where you behave as though there is no question that whatever you’ve been thinking is true. In this absence of observational distance, you behave as though you must do what you are think­ ing about doing because your thoughts about the world are unquestionably an accurate map of the world’s terrain. Imagine driving on a highway and following MapQuest directions on your smartphone. You come across a roadblock that detours you off the main thoroughfare. MapQuest shows no indication of this diversion; so, what will you do? With no readiness to act independent of direc­ tions supplied on the app, you might plow through the barriers and end up driving on unpaved rebar. Or you might take the detour but follow MapQuest back onto the highway, only to be detoured in a circle back to where you started in an endless loop. Of course, when navigating on the freeway, you easily recognize that maps are not neces­ sarily accurate depictions of the road. The possibility that a map includes distortions is easy to comprehend. But to the person fused with thoughts about what the world is supposed to look like, recognition that these expectations are merely verbal map renderings and not necessarily the way things are in the world is missing. Defusion is easily depicted as separating a bomb from its fuse. Once a bomb’s fuse has been lit, the simplest way to keep the incendiary device from exploding is by cutting off the fuse.

The View from Above: Six Repertoires to Practice Before the Going Gets Tough23

Defusing a bomb is analogous to defusing from thoughts that might otherwise have you acting in a way that blows up critical relationships.

Present Moment Awareness vs. Conceptualized Past and Future Times Being present involves focusing on the here and now, rather than getting stuck in the past or the future. We might get so caught up in remembering the way things used to be that we develop a concept that things are supposed to be that way, always. Alternatively, we might recall things that were unfair and see no chance that a current context could be anything less toxic. Focusing with an exclusive lens on the future can be equally detrimental. Perseverating on a looming deadline, court appearance, or contentious IEP meeting can leave us unable to focus on tasks at hand. Another matter is completing routines on autopilot, without attention to execution—in other words, inattentive behavior that can lead to accidents. We might also observe ourselves or others being easily distracted, jumping from one task to another, from work task to internet search, to social media, to coffee runs. The antidote, articulated in lay terms, is to show up for the present moment with active and voluntary attention. Doing so with openness to emotional and cognitive difficulties, without resistance to the discomfort, often requires uncoupling from seductive conceptualizations of an idealized past or future that is either better or worse than anything here and now. This is commonly referred to as mindfulness, which many ACT experts frequently define using Jon Kabat-Zinn’s (1994) formulation, “paying atten­ tion in a particular way: on purpose, in the present moment, and nonjudgmentally.”

Flexible and Inflexible Perspective-Taking In Mo’ Better Blues (Lee, 1990), Bleek Gilliam (played by Denzel Washington) sees himself as a horn player. A romantic partner bites his lip and he pushes her away in rage. His lips, his embouchure, those physical attributes encapsulate Bleek’s access to his sense of self. Without them, he cannot be who he sees himself to be. In an existential twist of fate, Bleek steps in to help a friend being beaten by goons who knock him to the ground and beat him with his own horn, which permanently injures his lip. Faced with the reality that he can never again play the trumpet and thus cannot be who he thought himself to be, Bleek spirals into a long, devastating depression. Inflexible perspective-taking of this kind results from envisioning oneself in a conceptual­ ized manner that is connected to only the narrowest set of circumstances. As situations change, the person with a constricted sense of identity, such as being a horn player and nothing else, finds themself adrift, desperately paddling against the tide for an inaccessible shore. From an ACT perspective, individuals can learn to relinquish such concepts of self in three ways. First, there is the acknowledgment of an active process in which self is constructed, pieced together from various experiences, categorized as patterns of action in context. There is nothing

24

ACT and Applied Behavior Analysis

wrong with being able to say that you have become more liberal, a sailor, or a grandmother. And it can be quite healthy to maintain some consistency with respect to how you aim to present yourself to others, so long as your presentation is sensitive to progressive or sudden changes in context. Taken to an extreme, this can be unhealthy. Imagine being unable to envision yourself ever taking a more nuanced political stance, unwilling to take work on dry land, or locked into a particular and unchanging image of what a grandmother is and is not. In these instances, self-concepts function as barriers to a full and expansive life. But by observing your label as a kind of nameplate that can be worn when it is helpful and removed when it is an impediment, you begin the process of using self-labels with contextual sensitivity. Second, there is the practice of engaging in ongoing observation of yourself through time. For example, noticing changes in the experience of your hair blowing in the wind as a breeze kicks up and dies down, recalling an experience of being in a ferocious wind as a small, frail child, imagining the perspective you might have in a blustering storm sometime in the future when you have cut off all your hair, and finally, noticing who is noticing as you think about each of these experiences. This ongoing knowledge of self that is both growing and stable through shifts in context fosters a more immediate kind of self-awareness. Noticing the thin line between stability and change leads to disentangling from idealized images of self. Third, a practice of generating observational distance over yourself, as though seeing your­ self from a point in the sky, provides the vantage from which to discriminate the conditions under which you do this, and those in which you do something else. After practicing this for a while, it is a short step to seeing that, to others, you are a this in this context and a that in other situations. These three practices have been called self-as-content, process, and context. Applied with flexibility, each is important to a person’s development and overall sense of identity. Overextended, any one of these can lead to the kind of spiraling despair from which Bleek Gilliam took years to emerge.

Valuing and Loss of Contact with Values A simple way to talk about values is to say that these are our heart’s deepest yearnings, what we want our lives to be about, the things we most intensely cherish and care about. Most of us learn what our parents and communities value during family meals, religious training, and school. We may or may not rebel, but at some point, we are encouraged to identify our own values. At another point, we could even be called upon to establish values for others at work or during community service. Sometimes, situations in life pull for action that is inconsistent with stated values. If we succumb for just a moment, we might sense that we have been fraudulent and seek to redress the matter. But if we persist over time in action that is unaligned with our values, we are likely to feel our lives absent of meaning or purpose. We sense that we have no values, or that we are so far from our values that from where we are, there is no way home.

The View from Above: Six Repertoires to Practice Before the Going Gets Tough25

Committed Action and Aimless Wandering This is where the rubber meets the road. Unlike other forms of therapy, ACT is explicitly about change in overt behavior. Said simply, there is no impACT without ACTion. In ACT, working on the left and center pillars of the hexaflex (acceptance and defusion on the left; present moment and selfing in the center) makes committed action efforts more attainable (see figure 2.1). By opening up to emotions and cognitions and gaining awareness of self and the now, there is little resistance to letting values pave the way to action. When behaving in alignment with your chosen values, you engage more fully with life in ways that matter. You have ups and downs, but you can witness these as part of the process. In fact, you may even begin to see breakdowns as necessary for having breakthroughs. Of course, there are more serious pitfalls along the way. When you approach things that matter with action, agonizing thoughts, emotions, bodily sensations, and memories of failure and hurt are bound to appear. The very things you’d worked so hard on in earlier ACT exercises return as you turn to act on matters of deep personal significance. It can feel as though you’ve done nothing, and that nothing you’ve done has impacted this moment. That is where all the practice you’ve done comes into play. In tennis, you don’t use your backhand swing during competition unless you’ve practiced it in many drills during the weeks and months leading up to the tournament. Backhand shots use muscles that are less well devel­ oped in most people’s arms, so it is common to try and run into a forehand position, which leaves you vulnerable to return shots placed far to the other side of the court. But the drills you’ve done during practice build confidence and skill for positioning yourself to take the back­ hand shot as it comes your way. ACT practice leads to this same kind of successful positioning when difficulties surface during committed action.

Figure 2.1

Present Moment Awareness Conceptualized Past and Future

Acceptance Experiential Avoidance

Psychische Flexibilität

Valuing Loss of Contact with Values

Psychological Flexibility

Committed Action Aimless Wandering

Defusion Cognitive Fusion

Flexible Perspective-Taking Inflexible Perspective-Taking

Figure 2.1

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ACT and Applied Behavior Analysis

Six Repertoires (a Behavior Analytic Framework for ACT) Now that you have a lay vocabulary of ACT, it is time to introduce you to a behavior analytic way of talking about it. Learning ACT in behavior analytic terms requires a slower pace, an adagio tempo. The concepts are difficult to explain precisely. But for starters, I prefer to speak about ACT in terms of repertoires, rather than processes. We are, after all, interested in chang­ ing behavior.

Acceptance and Experiential Avoidance, Defined Behaviorally A behavior analytic way of describing willingness (acceptance) is that it is behavior remain­ ing variable in the presence of aversive verbal contingencies. It is approach behavior toward private verbal and physiological stimulus events—approach that creates a context for more varied and adaptive responses that have a high likelihood of contacting natural, positive rein­ forcers. In contrast, inflexible behavior that is exposed to aversives rapidly becomes narrow, constrained to a small set of responses that in the past have resulted in avoidance or escape. Thus, experiential avoidance is a tight pattern of escape or avoidance responses in the presence of challenging memories, emotions, and bodily sensations. A behavior analyst might work with a gifted child who avoids raising her hand in class because when she has done so in the past, she perspired and felt embarrassed. It is possible, but unlikely, that the immediate effects of an intervention will lead to such a powerful boost in confidence that perspiration and its accompanying embarrassment will fall away. But that is not the point of a behavior analytic intervention, since our dependent variables are socially signifi­ cant, observable, measurable, overt behaviors. Reducing perspiration and embarrassment would not be suitable ACT aims, either. Consistent with ABA dependent variables, an ACT target in this example might be increasing the frequency of hand raising in class. Of course, perspiration could begin to lessen, and with it, so too would embarrassment. Presumably, the more positive reinforcement the child contacts when speaking in class, the less she will perspire and the less reason she will have to feel aversive emotions.

Cognitive Defusion and Fusion, Defined Behaviorally Fused behavior is responding under the control of rules that describe weak or nonoptimal contingencies of reinforcement. Rules such as “I have to        ” or “My expectation for myself is that I will        ” describe aversive negative reinforcement contingen­ cies. Rules such as these may have multiple functions. They may be discriminative for aversive self-stimulation (private self-punishment) if the contingency is not met. They may be establish­ ing operations for overt behavior that mitigates the repetition of these aversive self-statements.

The View from Above: Six Repertoires to Practice Before the Going Gets Tough27

These words may also have respondent functions; thus, any time an individual is in a situation where they have repeated these words to themselves in the past, the words, the situation, or its eventuality may individually or collectively elicit trembling, elevated heart rate, or other responses associated with anxiety. Conversely, defusion refers to a weakening of rigid rule control over behavior such that other functions can come to bear. Defusion strategies aim to disrupt restricted, circumscribed functions of private verbal stimuli such as thoughts so that a broader, more flexible repertoire of responding to those verbal stimulus functions might be established. A BCBA that observes a father’s movement becoming staccato and uncoordinated before it is time to practice a complex tact transfer procedure could inquire as to the most difficult things about the method. When the father says, “It’s just I’m supposed to have this down by now and I don’t,” the analyst might recommend writing that thought on a sticky note, attaching it to a beach ball, and trying to hold the ball out in front of him while trying the tact transfer procedure. After observing that the parent is even more awkward than before, the analyst might ask, “What else could you do with that thought?” Eventually, the parent ought to identify the option of laying the ball down at his feet while working with his child on the learning objec­ tive. After practicing the tact transfer procedure with the oppressive thought at his feet rather than in his face, the parent can be asked which course of action is more manageable.

Present Moment Awareness vs. Conceptualized Past and Future, Defined Behaviorally Responding effectively to stimulus events in the present context can involve focusing on a wide field of private events. For example, neutrally observing the flow of current sensations that in the past accompanied emotionally charged situations would be emblematic of this kind of present moment awareness. Alternatively, focusing on a narrow field of private events could involve dispassionately and curiously observing the degree to which you tremble as you write words on a whiteboard during a contentious meeting at work. As thoughts of past events come up, you gently return your focus to the movement of marker against whiteboard. The inverse of this would be behavior under the control of past or future contingencies of reinforcement and punishment. When your focus becomes overly broad and diffuse, you find yourself responding to past or future events and unable to speak or move effectively in the current emotionally charged situation. When your focus is overly narrow, you attend to some­ thing like the trembling of your hand while writing on the whiteboard so much that the content of your writing falls under defective stimulus control. You might look back on the words you wrote and reflect, “That’s not what I wanted to write,” then broaden your situational awareness to the needs of the moment and allow the broader context to acquire control over your writing in front of the group.

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Flexible and Inflexible Perspective-Taking, Defined Behaviorally Self-as-context, described above, could be interpreted behaviorally to be a repertoire of flexible perspective-taking. This could involve making adaptable self-statements, and similarly wide-ranging statements concerning others. In chapter 1, these behaviors with respect to self were described as trained deictic relations of I/you, here/there, and now/then. The result of deictic training is that an individual’s self-directed verbal behavior coheres but can change in the presence of private events that vary across time (e.g., memories of the past and concerns for the future), place (e.g., different situations, locations, relationships), and person (e.g., conflict­ ing perspectives about self and others). The flip side of this is behavior framed in terms of a single view of one’s own repertoire without regard to contingency demands of the current context. Rigidly applied deictic rela­ tional responses to person, place, and time often result in responses that include damaging statements about self or others. These statements, overt or covert, impede performance that might otherwise contact positive reinforcement. The practitioner working with an adolescent boy who says, “Yo, I’m a just a jock; I ain’t a geek!” might ask if there were ever times the boy described himself differently and if there were others in his life who might identify him differently. The practitioner could ask the boy to dribble a ball on the court and observe the effect, and then go the janitor’s closet and try to dribble the ball. To drive home the point, the practitioner might pose a question such as, “What if you were to play ball professionally and after a great run of ten years or so, open a business, like many star athletes have done? What kind of skills would you need then? Would you still be ‘just a jock,’ or would you be something else at that point, too?”

Valuing and Loss of Contact with Values, Defined Behaviorally Valuing might be described as behavior under the control of rules that function as verbal motivating operations that increase or decrease the effectiveness of stimuli as reinforcers or punishers and evoke behaviors that produce those stimuli. When a verbal stimulus augments the salience of delayed reinforcers and occasions behavior producing them, we say in RFT terms that the stimulus was an augmental. Repeating augmentals can have the effect of helping us recruit behavior that yields the most optimal shares of reinforcement. In this way, we act as our own listener, as Skinner suggested, and supply ourselves with supplemental stimuli to maintain behavior for which reinforcement is only remotely available. In contrast, behavior under the control of rigid or poorly articulated rules organizing a limited set of actions that lead mostly to smaller, immediately available reinforcers constitutes a loss of contact with values. Imagine supervising a behavior technician who tells you, “I just don’t see the point. I don’t care about data like you do. I just want to see these kids smiling is all.” You might ask the tech to list the things that make the children he works with smile now and then ask him to list the

The View from Above: Six Repertoires to Practice Before the Going Gets Tough29

things that are likely to make these same children smile fifteen years from now. If in a few years, the children will want to be independent, then maybe playing without taking data on skill acquisition is not in their long-term best interests and not consistent with what the tech cares most about—seeing them smile. Data collection, you might explain, is necessary for evaluating academic gaps that the tech is in position to remediate. If he cares about seeing the kids he works with continue to smile over time, maybe he would be interested in reevaluating his rela­ tionship with data collection.

Committed Action and Aimless Wandering, Defined Behaviorally Committed action can be said to be behavior that has a high probability of contacting larger, remote reinforcers. Such behavior foregoes the option of responding in a way that con­ tacts smaller reinforcers that are immediately available. Acting with respect to important, delayed reinforcers is often accompanied by aversive stimulation in the form of anxiety, since it is unclear whether an action today will yield the desired reinforcer tomorrow. Skinner (1953) suggested that anxiety consists of conditioned responses (e.g., sweat, trembling, heart palpita­ tions) in the context of action that has in the past sometimes been reinforced and other times punished. The availability of reinforcement for current behavior is uncertain, an unstable con­ dition that elicits the responses mentioned above. The easy course of action is to act in a way that terminates this aversive condition immediately. Of course, this means foregoing the larger appetitive. “I just want to give up; I failed the diagnostic BCBA prep exam twice, even after studying for a month,” said Anna, a graduate student, to her professor. Dr. Baker asked Anna to identify the function of her verbal utterance. Anna quickly smiled and said, “I guess I just need coach­ ing.” Dr. Baker then asked Anna to identify how she wanted to show up for her own kids at home. When Anna said that she wanted to show them that they could do more than just survive, that they could thrive if they worked hard, Dr. Baker asked her to pinpoint just one single behavior she might engage in today that would be more in sync with her values than giving up. Anna was initially irritated by her professor’s unwillingness to let her off the hook. Nevertheless, in the end, she committed to another three months of ongoing, intensive exam preparation, self-monitoring her progress, and sharing her practice session length and mock exam accuracy data with Dr. Baker.

Six Repertoires Redux In longer musical works, composers often bring back themes from earlier movements in an altered format. Perhaps the tempo is softer, or there are more embellishments as minor motifs are expanded.

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ACT and Applied Behavior Analysis

Thus far, I have made the case that the six ACT components can be discussed in lay terms or, alternatively, in relatively adequate behavioral terms. But there are many situations in applied practice that call for improvisation and sampling. The fact is, the hexaflex is an unwieldy tool to teach others. In chapter 3, I will introduce you to the ACT matrix, a remarkably simple tool for working through much of the hexaflex without talking about the six component parts. But there may be circumstances that call for a heuristic with which you can teach individu­ als to tact their own repertoire deficits and excesses in an ongoing manner. A simplified hexaf­ lex would be beneficial to help newer ACT learners discriminate their own needs and intervene on themselves effectively. One way to distill the ACT model is to break it into fewer parts while keeping all the com­ ponents in play. A biflex modeling of ACT involves teaching learners that ACT is about acceptance and action (see figure 2.2). You can build defusion, attention to the now, and flexible perspective-taking into acceptance work. Likewise, you can build focuses on the now, perspec­ tive-taking, and valuing into committed action work. Thus, acceptance and action can serve as a brief way of introducing ACT repertoires when time is limited. Another option is to break the model into three parts. A triflex modeling of ACT might be termed open, aware, and active, in which the left, center, and right portions of the hexaflex are divided into three pillars for assess­ ment and intervention (see figure 2.3). This provides a little more precision than the biflex model, and still a great deal more efficiency than the hexaflex approach. Of course, as with the biflex model, all ACT components are present and must be addressed, but this way of concep­ tualizing and introducing the model can speed cognition and behavioral adoption. Finally, there is my own iteration, a quadflex model (see figure 2.4). I find with many popu­ lations that the following acronym is quite powerful: DARE to Connect. DARE stands for defuse, accept, recenter (which includes both of the center hexaflex repertoires), and engage (which incorporates both of the right hexaflex repertoires). The opposite of DARE is FEAR, an acronym first introduced in the 1999 ACT book by Hayes, Strosahl, and Wilson. FEAR stands for fusion, experiential avoidance, and reason-giving.

ACCEPTANCE

Acceptance Defusion Present Moment Awareness Flexible Perspective-Taking

Psychological Flexibility

Figure 2.2

ACTION

Present Moment Awareness Flexible Perspective-Taking Valuing Committed Action

The View from Above: Six Repertoires to Practice Before the Going Gets Tough31

Figure 2.3

re 2.4

OPEN

AWARE ACTIVE Present Moment Awareness

Acceptance

Valuing

Psychische Flexibilität

Psychological Flexibility Defusion

Committed Action

Flexible Perspective-Taking

Figure 2.3

DEFUSE ACCEPT RECENTER ENGAGE (DARE to Connect) ACCEPT

RECENTER

ENGAGE

Present Moment

Valuing

Acceptance

Psychische Flexibilität

DEFUSE

Psychological Flexibility Committed Action

Defusion

Flexible Perspective-Taking

Figure 2.4

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ACT and Applied Behavior Analysis

DARE is my way of bringing jazz to ACT in ABA. It’s all in the jam. When I’m fully into DARE, I’m inviting you to play inside an improvisational groove using words and exercises that don’t sound anything like ACT or ABA. The ACT is there, as is the ABA—but you might mistake it for a kid’s schoolyard game or a camp team-building exercise. You wouldn’t be wrong. But you wouldn’t be right. Like ABA, ACT is not a single technology. It’s a model of human psychological flexibility. Discovering when to use the six middle-level terms, behavioral terms, or the bi-, tri-, and quadflex versions of the ACT model is a bit of a free operant preparation. You’re going to have to go out there and try these things to see what works best for you in various situations. I could give you a set of rules, but then your behavior would become rule governed in an inflexible way. I’d rather see you go out and fall on your face a few times but engage in what Skinner (1953) referred to as “hot” learning—after contacting the cool, warm, and hot edges of the contingen­ cies, you know what works for you in an experiential way. That’s exactly what we are asking our clients and employees to do, so it makes sense that you, too, should flexibly go out and try a few novel behaviors. You’ll discover what works for you as well as what does not.

Reprise Flexible behavior in the context of difficult circumstances involves a combination of several repertoires that, for teaching purposes, can be parsed into six classes of behavior. In this chapter, I introduced these skill sets in several different ways. I made the case that physical stimuli have multiple functions and do not exist as things in the world, but rather as functions related to other events that change under the selection pressures of different contexts. The terms used to describe these stimulus functions vary as the context changes. Likewise, I made the case that the terms used to identify components of behavioral flexibil­ ity can be adjusted to meet the needs of different populations and circumstances. I introduced traditional terms used to depict ACT processes, more precise behavior analytic descriptions, and user-friendly behavior analytic ways of unpacking these skill sets. Finally, I discussed the conditions under which describing ACT repertoires in a triflex and biflex model could be more beneficial. The aim of this chapter was to provide an overview from which behavior analysts can begin assessing and targeting verbal behavior for change. It may seem as though you’d be making a mistake to talk about ACT “processes” when talking to behavior analysts. Likewise, it may occur to you that talking about stimulus control, response generalization, and delay discounting would be inappropriate in front of parents or other professionals. You may be correct on all of these counts. It is best to develop some skill at using the right verbal repertoire with each of the varied audiences you encounter. But no doubt, you will make mistakes. You will use words in a clunky way. You will notice yourself missing with people. Welcome. You are a learner. So am I.

The View from Above: Six Repertoires to Practice Before the Going Gets Tough33

We make mistakes. We miss sometimes. We learn to recover the groove. Herbie Hancock tells of a time when he was very young and on stage with Miles Davis (SafaJah, 2014). They were far down this intricate melodic maze and the moment called for G major 7th. Hancock tried to hit it but missed. He played the wrong note, and well, it was really wrong. He quickly went into judging and hating himself, but Miles just reacted by playing a set of notes around what Hancock had played that made it all right. Miles didn’t hear it as a mistake. He heard it as an event, an opportunity, another cavern to explore in the maze. To Hancock, this was a substantial life lesson that Miles had given him. When you hit a wrong note, it’s the next note you play that determines whether it’s good or bad. He quotes Miles as leaning into him to say, “Do not fear mistakes. There are none.” In ACT too, there are no mistakes. It’s what you do right now, after hitting that last note you played, that matters most.

CHAPTER 3

ACT Functional Assessment and Functional Analysis

Functional Assessment in ABA Acclaimed physicist Richard P. Feynman wrote, “What goes on inside a star is better under­ stood than one might guess from the difficulty of having to look at a little dot of light through a telescope, because we can calculate what the atoms in the stars should do in most circom­ stances” (Feynman, 2011). As Feynman’s description of the atom suggests, scientific ways of knowing begin with an assumption of lawful and orderly relations between phenomena of inter­ est and surrounding events and end with a fully functional account of their occurrences. The scientific practitioner’s job is to employ procedures that convincingly demonstrate the circum­ stances in which particular events transpire. Accordingly, functional assessment (FA) is the practice of uncovering the variables of which behavior is a function and the conditions under which behavior most frequently occurs. A defining feature of ABA is the use of analytic procedures to identify putative variables responsible for a behavior’s occurrence. Characteristic antecedent conditions that include moti­ vating conditions, discriminative stimuli, and conditioned stimuli can be identified and changed to prevent unwanted behavior and improve learning. Consequent conditions are classified as punishing, reinforcing, positive, negative, conditioned, or unconditioned in order to improve the practitioner’s likelihood of evoking desirable behavior and altering the payoffs that main­ tain unwanted performances. Behaviors are defined topographically when information about the controlling variables is unavailable to the practitioner, but after these conditions have been identified, function-based definitions are preferred. In many cases, the topographies of behavior offer little information as to the situations in which a behavior is most and least likely to occur; thus, functional assessment is vital to increasing the practitioner’s capacity to influence behav­ ior change. In ABA research and some practice facilities, analog functional analysis is conducted to ascertain precise, quantitative information pertaining to a behavior’s controlling variables. Through a program of research that has spanned decades, a wide variety of functional analysis procedures have been evaluated in which variables are systematically manipulated to accurately

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account for the conditions that maintain behavior that occurs under the control of direct-act­ ing contingencies of reinforcement. Variants include the full, brief, single-function, precursor, latency, trial-based, and interview-informed synthesized contingency functional analysis procedures. Two additional well-studied classes of procedures are indirect and descriptive functional assessments. Indirect functional assessments involve interviews, checklists, rating scales, and surveys that are quick and easy to implement. Although practical, these procedures provide no quantitative data and call for the subjective impressions of respondents who may not under­ stand the questions, may not know the answers, or may have reason to under- or overreport occurrences of a behavior in question. In contrast, descriptive functional assessments involve direct observation of behavior in context; thus, these procedures yield some quantitative data that can be collected repeatedly over time. However, in these techniques, no manipulation of direct-acting variables is attempted. Therefore, low-rate behavior may not occur during sched­ uled observations and the procedure may not uncover the putative variables or the amount of variance for which these conditions account. All this suggests the need for experiment-based, analog functional analysis strategies. Nevertheless, analog procedures require a high degree of expertise and sufficient resources, including time, personnel, and facilities. Moreover, functional analyses can temporarily increase the frequency of unwanted behavior and jeopardize the safety of practitioners and others in the milieu; thus, in many cases they are unacceptable to stakeholders. Although precise functional analysis procedures that are efficient, cost-effective, and easy for teachers or paraprofessionals in a variety of settings have been investigated, there remains a prevailing view in the field that indirect and descriptive procedures are at the very least a useful starting point, and in many cases sufficient for identifying the environmental determinants of both unwanted and desirable behavior. Recently, a procedure that rests midway between descriptive and analog function evalua­ tion procedures has been proposed in which motivating operations are hypothesized based on indirect procedures and manipulated by the mediators that typically encounter problem behav­ ior in natural contexts (Cipani & Schook, 2007, 2011, 2018; Rolider & Axelrod, 2000). Termed the trigger analysis, motivating antecedent triggers are carefully contrived in the form of a withdrawal-reversal design experiment during brief conditions engineered in the ordinary cir­ cumstances in which the behavior normally occurs. At the time of this writing, no published research exists on the trigger analysis. Nevertheless, the trigger analysis is thoroughly grounded in established principles of behavior. I have used it repeatedly in clinical practice and found it to be more helpful than indirect or descriptive procedures, and more efficient and cost-effective than analog functional analysis. It is a kind of “down and dirty” clinical tool that meets practi­ tioner needs without sacrificing precision and meets Baer, Wolf, and Risley’s 1968 call for empirical, experiment-driven, and replicated findings. Importantly, this is a technology that is well suited to testing suspected indirect-acting contingencies that are framed in this volume as inflexible verbal repertoires.

ACT Functional Assessment and Functional Analysis37

If ACT is indeed a model of psychological flexibility that can be used within the scope of practice of applied behavior analysts, then practitioners should have access to functional assess­ ment tools that uncover important controlling variables—the kind of indirect-acting contin­ gencies that ACT is intended to address. To that end, some ABA ACT researchers are investigating the use of ACT self-report scales in applied settings. Given that the bulk of FA research shows self-report scales have low correspondence with experimental FA results, I elect to stay clear of this practice. Instead, in this chapter, I propose elements of an ABA ACT func­ tional assessment to expose verbal “tells,” or topographies associated with ACT processes, and an ACT functional analysis procedure that supplies functional evidence in the form of a rapid, in-session ABAB reversal design. Additionally, I propose the use of exercises that augment relational framing repertoires to further investigate the conditions under which verbal traps narrow behavior in ways that curtail access to positive reinforcement. But before advancing any of these procedures, I want to begin by addressing an issue that is important for ABA practitioners considering the use of ACT. On what basis would you stick to the assessment of observable, measurable environmental determinants that are easily con­ trolled in ABA work, and under what conditions would you elect to consider paradoxical and somewhat unobvious ACT interventions in the context of ABA practice?

When Not to Do ACT The aim of ACT is to increase nimble, wholehearted responding that is accountable to both historical and situational contexts. Helping a client become responsive to the optimal contin­ gencies of reinforcement does not mean that the client will by course feel terrific during or even after the intervention. A child with low-functioning autism gains access to important reinforc­ ers during the course of an ABA session, but it would not be accurate to say the child feels content or even less anxious after a lesson is concluded. Likewise, if a client has strong verbal skills and is asked to engage in difficult actions that will yield powerful reinforcers, the behav­ ioral event may produce important payoffs, but in the short term, this event may still be accom­ panied by difficult emotions and bodily sensations. Although a client in such circumstances may voice their discomfort, it does not necessarily follow that a practitioner needs to directly address the client’s feelings of discomfort.

Mr. Grove and the Power of Direct Contingency Management Imagine Mr. Grove, for example. Mr. Grove is the dad of a boy you work with. He is driving to pick up his kid from school when there’s been a fight. Mr. Grove may be noticing a flurry of difficult thoughts about himself, how things used to be, how he sees himself as a father, how he sees his son and his son’s friends, and how things ought to be. He may be sweating, trembling,

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physically cramping, and emotionally panicked at the thought of having to face the school’s principal. In all of this, he could be that father who shows up with concern for the other child involved and the school, respect and compassion for the principal, and a willingness to hear all sides before deciding how to respond. Now imagine that en route to his son’s school, Mr. Grove receives an urgent phone call from someone at work that is asking him to return to the office immediately and step into a meeting with clients to seal an important business deal. Mr. Grove phones you to say that he is unable to pick up his son and talk to the school principal; instead, he asks you to discuss the matter with the school administrator and represent his son as you normally would if he were there. You may be tempted to have a conversation with Mr. Grove about his deepest longings for his child and who he wants to be at this moment in his son’s life. But in this situation, a simpler, more expedient course of action is to withhold the reinforcer and let Mr. Grove know that you will not go to meet with the principal unless he is there, but that should he rearrange his work schedule and go to his son’s school, you will go and stand by his side. You let Mr. Grove know that you’re aware how difficult this is, and then you leave the decision to him and let his behav­ ior come under the control of the contingencies of reinforcement. If you are working with Mr. Grove as his son’s behavior analyst in this situation, regardless of any hard and uncomfortable private events he should come to discuss with you in the process, there is no need for an ACT intervention. You are there to support Mr. Grove and teach him important parenting skills. In this situation, you have the tools to be contingent, to model effec­ tive behavior, and to generate Mr. Grove’s successful action in context. You manipulate the contingencies; the contingencies alter his behavior. Direct contingency management (DCM) is the stock and trade of ABA. There is no reason to abandon it in favor of the paradoxical verbal approaches of ACT when powerful, direct-act­ ing environmental variables are within your power to manipulate. In this hypothetical situation with Mr. Grove, you hold a remarkably effective reinforcer in hand—your presence at a difficult meeting with a school authority. By caringly stating that you will offer that reinforcer contin­ gent upon Mr. Grove rearranging his work meeting to attend his son’s meeting, you are being ACT consistent in the most powerful way. You are being contingent and compassionate. But you are managing the situation using DCM strategies, saving ACT for those times when directacting variables are not within your reach or are too slow to make a difference. Let’s look at another example.

Mai and Using ACT If Direct Contingency Management Fails Mai is an RBT who is working with Mr. Grove’s son, Saul. Saul is emotionally intimidating to Mai, who is usually demure. To date, Saul has no history of aggressing toward any adult, but he is quite large and scary to Mai. Saul raises his voice with Mai because when she first started

ACT Functional Assessment and Functional Analysis39

with him and he did so, she withdrew demands. Asked why she did this, she said that she thought she may not have paired herself enough with reinforcement, so she thought it best to slice back and continue pairing, rather than lean in with demands. She recognizes that in doing so, she may have inadvertently shaped Saul’s repertoire of raising his voice in the presence of demands from her. Mai has come to you for help. She tells you that she can see how she duped herself, feels bad about it, but knows that she and her skills are strong enough to press on with Saul. She is just not certain that you would see it as being an acceptable risk, so she is asking for confirmation that using escape extinction and offering Saul a break contingent upon his completing three academic tasks would be satisfactory. You wonder for a moment whether Mai is unwilling to take on the responsibility of risk, something that you value in your own work. Can she accept the discomfort of not knowing for certain what is the best course of action, making her best guess, and working with the outcome? At the same time, you are careful to evaluate whether you have access to the environmen­ tal variables that would support Mai to be successful with Saul. Shifting the contingencies of reinforcement would certainly be necessary, but would this be sufficient for helping Mai take effective action in this situation? Given what you know in this situation, consider whether you will use a DCM or an ACT strategy with Mai and why. On balance, it seems important to reflect on Mai’s relative inexperience. She is, after all, an RBT, and not a seasoned BCBA or even a BCaBA. She has obviously paid attention in her training to such matters as pairing, slicing back, and shaping the wrong client repertoire, but her own behavior has not yet been shaped by situations like this one to the point of being sure enough of herself to take action without checking in with her superior. It would be tempting but most likely ill advised to push Mai to make this kind of decision on her own. Rather, it seems fitting to reinforce her asking for guidance. Additionally, you might help her evaluate the envi­ ronmental factors to which Saul is most likely to respond favorably in the long run, even if in the short run he raises his voice louder than he has in the past. You imagine that later in her development, you’ll want Mai to accept the ambiguity of this kind of situation when weighing the historic and current situational variables to make a suitable decision. But at this juncture, it seems right to use DCM and reinforce Mai’s evaluation of her own performance, her assess­ ment of the next step that she should take, and her coming to you for guidance. You might ask her to set a goal for this week as well as a few smaller objectives and ask that she send you a quick email later in the week to let you know how things are going. You might check the data in Catalyst later in the week too, and promptly offer positive reinforcement when she uploads data, even if there is evidence of a larger than usual extinction burst from Saul. In other words, here again is a situation in which careful evaluation of the circumstances provides evidence of direct contingencies that can be controlled to influence behavior. In this situation, ACT could be used, but is not essential to helping Mai perform effectively. One more example would be helpful before moving on.

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Dov and ACT as an Adjunct to Direct Contingency Management Dov is eight years old. He is autistic with mild support needs and has been receiving homebased ABA services for four years. His parents tell you that Dov is refusing to go to Hebrew school on Sunday. He goes on Wednesdays after school and reports to his parents that he likes the kids and teacher there. When you meet with Dov, he tells you that Sunday is when his nextdoor neighbor and best friend plays football with his brothers. It is the only day of the week when they all play together because they each have other obligations throughout the week. Dov says that when he plays with this group, he is learning all about football and making good friends. He can play with his best friend and some other kids at school on Thursday after school. But he doesn’t know them that well and they are better than he is, so it is more challenging. Instead, he prefers to come home after school on Thursdays and wait until Sunday to play with neighbors he knows and around whom he is the best at the game. Dov’s parents could easily make him go to Hebrew school on Sunday or ground him if he refuses. However, they ask you to talk with Dov to see whether there is another solution that they have not thought of. You begin by asking whether there are other options, such as Saturday Hebrew school or an additional evening that Dov could attend instead of Sundays, and you are told that these are not options. You have conducted a preference assessment with Dov and know that the oppor­ tunity to play chess with you is a highly preferred reinforcer. But when offered to Dov, in com­ parison to the reinforcers for playing football with the neighbors, this does not attract him. At this point you wonder whether to ask his parents for an even stronger reinforcer or to engage Dov in an activity in which he will identify the things that are most important to him as his “values.” Given what you know in this situation, write down whether you will use a DCM or an ACT strategy with Dov and why. It is possible that if you turned a few more stones, you might uncover a way to manipulate variables that will satisfy Dov and his parents. However, given the information you have, that seems unlikely. Dov’s reinforcers are really not in your hands, so there is no way to temporarily withhold something to contrive an establishing operation (EO) here. In fact, Dov’s behavior is controlled by an EO over which you have no control—you cannot ask the neighbors to play with him on another day because they all have other obligations throughout the week. The discriminative stimuli for Hebrew school are salient enough; that is certainly not a problem. Moreover, Dov is a bit young to be having a conversation about his “values.” Obviously, his parents value religious education and this will be an important aspect of Dov’s participation in his family life. But it would be coercive to tell Dov that he should value what his parents do or to try to convince him to care about things in the same way that they do. DCM strategies are linear and straightforward. In this case, none are immediately very strong candidates. In contrast, ACT strategies for children Dov’s age would likely need to be idiosyncratic—not cookie-cutter versions of those that you find in protocols and books (although see excellent treatments in Dixon & Paliliunas’s AIM [2018] and Hayes & Ciarrochi’s The Thriving Adolescent [2015]). With a kid like Dov, you might find it useful to be creative.

ACT Functional Assessment and Functional Analysis41

Later in this volume, you will learn a variety of ways to introduce valuing with a child of Dov’s age, intellectual stage, and emotional development. It is vitally important that these factors be considered when creating an ACT intervention, as is the case when creating a DCM interven­ tion. For our purposes here, it is sufficient to say that a good choice would be to craft an ACT valuing intervention that is fun and playful. For example, you might play a few games with Dov and offer him the opportunity to win repeatedly or to advance to the next level—the ninja level of the game—where he might have to learn and practice a few new skills before he can once again be the best. Once Dov has selected and experienced this kind of advancement, you can then have a conversation with him about joining the team that plays on Thursdays, learning from them, and making friends there. In this situation, short of an establishing operation that makes a reinforcer powerful enough to influence performance and with no lack of discriminative stimuli to occasion desired behav­ ior, ACT becomes a viable adjunct treatment. Targeting the right ACT repertoire is the stuff of this chapter and tailoring treatment to the individual at hand is the stuff of the remainder of this book.

Above All, Be Kind I’m going to make this point again later in this chapter, but it is important enough to discuss in the context of the functional assessment of DCMs and again when addressing the evaluation of indirect-acting contingencies: above all, be kind. Behave with the utmost of humility when assessing the function of another’s behavior. Think of the person you are treating as the captain of the ship you are boarding. You have been invited on as the navigator. Your skills are needed, but you are not the boss. It is scary to invite professionals into your life. It is your life, after all. Who are these experts who are inspecting your routines and telling you what to do? What are their credentials? So what if they hold this degree or went to that school—have they raised two children and seen them off to college? Have they cleaned and changed their own child’s feeding tube? After learn­ ing that nothing they do from here on in will change their child’s inability to speak or read or write, have they cried against a pillow to keep from waking others, then gotten out of bed to prepare meals, get clothes ready, and get kids on the bus? And have these experts assessing your every action ever once looked at you smiling, saying yes to them, and seen the agony under­ neath? The despair? The uncertainty? Whether you end up conducting an assessment of indirect-acting contingencies or sticking to a DCM functional assessment, be kind. Establishing trust requires that the people you meet experience you as someone who will meet them in their most vulnerable places with care. They need to know that you will show understanding and that you will not judge them harshly when they falter. And they will falter. As will you.

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If you are willing to notice the trembling of your own calves as you step into the room in which you meet, then you can imagine the trembling heart of the human you are there to help. Even if you cannot see it. They are trembling. They are frightened. Anxious. And they are doing their best. As are you, stepping out of your own comfort zone, trembling, trying hard to appear confident. Greeting the person in the mirror with kindness may be an excellent first step to showing compassion for the person you meet when conducting an FA. Acknowledging with the person you meet that this is hard and that you respect them for letting you in is the second step, and it is equally important. Salute the captain when you board their ship. And above all, be kind.

Review: When to Use ACT and When to Stick to DCM Strategies in the Course of ABA Treatment To review, the first step in an ACT functional assessment is to do what you have learned to do in your behavior analytic training: 1. Identify a socially relevant, observable, measurable behavior that you are targeting for change. This is so important that it bears repetition throughout this volume: there is no such thing as an “ACT goal” distinct from an ABA goal. ABA practitioners target socially important overt behaviors for change; these are our dependent variables. 2. Look for MO, SD, CS, EXT, SR, and SP variables that can be manipulated to improve the probability of effective behavior. If manipulating these variables results in observ­ able and durable behavior change, there is no reason to do ACT work. 3. On the other hand, if these variables are unavailable or working too slowly to produce important changes in a client’s behavior, ACT could be an important treatment adjunct. Now, let’s say you have targeted an important overt behavior for intervention and found that you do not have access to the reinforcers and discriminative stimuli that would affect the desired change. You are considering an ACT intervention. But where to begin? Do you conduct an eight-session protocol that you read about in the Journal of Contextual Behavioral Science? Do you refer the client to a psychotherapist because they tell you that they feel anxious when you give them a task to carry out? My position in writing this book is that functional assessment tools for pinpointing indi­ rect-acting contingencies impeding desired behavior are available and easy to use. Additionally, my position is that ACT can be used in brief formats that are distinct from talk therapy itera­ tions of psychological flexibility work. In the remainder of this chapter, you will learn to distin­ guish topographically relevant verbal “tells” and test them to see whether they are important

ACT Functional Assessment and Functional Analysis43

controlling variables. This will enable you to conduct brief, precise ACT in order to jump-start behavior that might otherwise be difficult to bring to strength.

Verbal Tells and Reads One of the first things you learn when studying the game of poker is that you don’t play your cards so much as you play your opponent. There is a great deal of strategy involved in winning poker, one aspect of which is listening to and learning the verbal behavior of individu­ als at the table. A single word of phrase can contain several bits of information in the form of: • Literal word meanings (these offer as little information in therapy as they do in poker) • The meaning of the words used in context (word meanings are found in the control­ ling variables, only some of which are available for inspection) • Changes in volume, pitch, and emphasis (autoclitic frames, all of which are available for immediate inspection, but which are difficult to measure without video and require very careful inspection to analyze effectively) Skinner’s taxonomy of meaning in verbal behavior offers a worthwhile starting point for understanding the meaning of a verbal utterance. Skinner (1945) suggested that operational definitions do not suggest meaning unless they are robust in fully identifying the motivating, stimulating, discriminative, and reinforcing conditions in which a word is used. Only with this kind of information can you know the meaning of a word or phrase. The problem in poker, and in analyzing psychologically tricky verbal behavior more gener­ ally, is that these controlling variables are not always available for inspection. In poker and in functional assessment, we may start by examining verbal reports, but we quickly move to other methods to ferret out the controlling variables because the person seated across from us may be misdirecting us, whether by accident or on purpose. So, the first step is to listen for words that are tells from which to derive an inference. At best, this is a guess, and it is just a starting point. It may be wrong or only partially right. The words a person says may lead you simultaneously in two or more combined directions on the hexaflex, or jet you in what seems to be two divergent paths that are equally possible but incom­ patible interpretations. It seems Skinner was right when he wrote, “Behavior is a difficult subject matter, not because it is inaccessible, but because it is extremely complex. Since it is a process, rather than a thing, it cannot be held still for observation. It is changing, fluid, and for this reason it makes great technical demands upon the ingenuity and energy of the scientist” (Skinner, 1953, p. 15). Nevertheless, the words people use offer many hints concerning function that should be investigated. These may be referred to as tells, and they are an excellent starting point from which to draw inferences. Volume, pitch, emphasis, and other forms of body lan­ guage are reads that should be considered as well before conducting an ACT functional analysis to further expose the important controlling variables.

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Free Tools at the New Harbinger Website Space restrictions limit the discussion of descriptive assessment relevant to ACT that follows to a description and a few examples. My experience after teaching thousands of people to evaluate tells and reads is that discrimination training methods are necessary. On the New Harbinger website for this book, http://www.newharbinger.com/45816, you will find discrimination training exercises related to this chapter and others. Discrimination training on the website for the section below begins with fusion/defusion, then moves to fusion/experiential avoidance, then fusion/experiential avoidance/loss of contact with the present moment. Subsequently, each of the other six repertoires is added to the training samples. Also on the website you will find explanations of how to identify the most relevant repertoire for each example.

Fusion vs. Defusion When a person’s behavior falls under the control of rules that describe weak or nonoptimal contingencies of reinforcement, we say that their behavior is fused to their private renderings of the situations they face. Somewhere along the way, they learned or scripted rules of engagement that serve as vice grips, constraining them to respond just so. Adherence to the rules brings about a sense of coherence that is either prescribed by some higher, but detached authority or by social convention. Verbal tells to listen for include: • Rules stated as though they are unbreakable tenets • Reasons why specific actions are inevitable • Stories that seem to have been told many times over • Unwillingness to entertain new ideas Reading fused quality in verbal behavior may involve listening for overly dramatic cadences and flourishing pitches or monotone drones, which can make it initially confusing to listen for. However, in each of these there is a rehearsed quality and a prejudged sense that whatever is being discussed is true. Examples in speech might include: • “I have to / should / can’t / am supposed to…” (could be he / she / they / it) • “This is my expectation of you / them” • “It’s supposed to be / not be like this” • “I did it for the good of the group / for their own good / for my family” The flip of fusion is defusion, which is behavior that may be responsive to rules but in a contextually adept way, while being equally responsive to nuanced changes in the direct

ACT Functional Assessment and Functional Analysis45

contingencies. Defused behavior is coherent, but unlike fused behavior, here the coherence is functional. That is, as circumstances change, the rules change consistent with changing condi­ tions in the environment. Verbal tells include: • Rules are stated as general guidelines instead of lockstep prescriptions • Reasons have a tentative and unfolding character to them • Stories include an element of surprise, even in the telling, as though there is something being discovered in the telling • New ideas are not integrated into old ones, but are inspected as potentially new infor­ mation that changes a prevailing interpretation of events If you were to ask an individual to tell their story a second time, a defused story would be told differently, with novel emphases, and a pitch and volume that shift as ideas are presented in new ways. Defused verbal behavior is marked by curiosity about events and the various pos­ sible determinants that are unobvious but worthy of consideration. Examples could include utterances such as: • “I tend to think this, but it may not be the way I see it.” • “They want this, and though I tend not to, it may make sense to give them what they want.” • “I’m noticing a pull to acting in this way, and I’m going to pause in order to gain perspective.”

Experiential Avoidance vs. Willingness Behavior that is tightly constricted in the presence of aversive self-stimulation is experien­ tially avoidant. This is different from direct experience avoidance. Direct experience avoidance involves shrinking away from people, places, and events that previously evoked behavior that contacted extinction or punishment. In contrast, experiential avoidance is when a person’s behavior is focused on eliminating or controlling memories, emotions, or thoughts about diffi­ cult people, places, and events. Said differently, direct avoidance is about avoiding real-world happenings whereas experiential avoidance is about avoiding private events about those hap­ penings. Verbal tells to listen for include: • Unwillingness to discuss details of events, people, and feelings that have been painful • Sarcastic or cynical jokes that deflect away from direct communication on sensitive topics • Statements that the private events they are facing are too painful to openly examine

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Experiential avoidance is easy to read because when difficult emotions or experiences come up, the avoidant individual is quick to change the subject, find something that needs their immediate attention, bark out wisecracks that make light of the situation, or argue forcefully that they don’t have to face their painful experiences directly. Experientially avoidant body language is also easy to read: you may observe a person clutching their hands, folding their arms in a closed way, sinking their shoulders, averting eye contact, or clenching their fists. Examples in speech could include: • “I simply can’t have this emotion / bodily sensation / memory.” • “It hurts too much; I don’t want to think about it.” • “Leave me alone; there’s nothing wrong!” • “I just want to be happy and for all this pain to go away.” The opposite of experiential avoidance is willingness (acceptance). Willingness is observed when a person’s behavior remains supple in the presence of aversive private stimulation. Verbal tells include: • The capacity to sit with uncomfortable feelings, etc. • Verbal recognition that trembling, heart rate changes, dry mouth, and perspiration are potentially positive signs of growing or healing To read willingness, observe what a person does when difficult topics are brought up in conversation. If there is soft but focused eye contact, open discussion of private events that accompanied difficult experiences, or affiliative humor that is accompanied by an open posture and relaxed hands, arms, and shoulders, you are likely observing a person’s willingness to open up to difficult affective experiences. Examples could include utterances such as: • “This hurts; but I can be with it.” • “I’m sweating like a faucet and I can’t hold my pen in my hand without shaking. Maybe this means there’s something in this for me.” • “Someone once told me that what doesn’t kill you makes you stronger. This isn’t killing me, even though I thought it would. I’ll probably end up stronger for it.”

Loss of Contact with the Present Moment vs. Present Moment Awareness When behavior falls under the control of past or future contingencies of reinforcement or punishment, an individual does not attend effectively to the present moment and instead shows preoccupation with the past or events yet to come. Loss of situational awareness can also involve

ACT Functional Assessment and Functional Analysis47

being disorganized or easily distracted. On the other hand, it might also be characterized by intense overfocus on one thing in the current environment to the exclusion of everything else. Verbal tells to listen for include: • Repeated talk about past or upcoming events • Unwillingness to talk about past or upcoming events • Easily getting distracted by emails, texts, phone calls, etc. • Singular focus on an activity so as to tune out the rest of the world Reading inattention to the now requires that you maintain a soft focus on the current environment so that your own behavior comes under the control of important stimulus events as they arise. You will detect a client’s inattention to the current situation if you are well attuned and they are not. You might mark events as they occur and measure the latency with which a person’s attention shifts to and from these occurrences. Slow or nonexistent orientation to changes in the immediate context is a sure sign of this lost contact with the present moment, but so is hypervigilance, characterized by jerky movements and easily disconnected eye contact. You might observe changes in a person’s immediate body posture (this includes wincing, fist clenching, and shoulder position) as topics related to a difficult past or future situation come up in conversation, in musical lyrics, or movies. Examples in speech could include: • “She hurt me back then, so why should I take her call now?” • “The IEP meeting is next week, so I just need to focus on that. Can we have coffee in two weeks?” • “I’m just all over the place; I don’t know what to do right now.” • “I hear you; I know you want to talk, and I know it’s important, but I’m busy right now; I’ll come out later.” When someone is present, their behavior is suitably under the control of present events such that they can learn from the past and plan for the future without sacrificing engagement in the here and now. Verbal tells include: • Persisting or changing as the overarching context dictates • Speaking of the past or the future with cadence, volume, and pitch that matches others’ in the conversation • As events change, cadence, volume, and pitch change in a way that reflects adequate orientation to these new events You can read presence in a person because they bring a suitable level of focus to unfolding events, neither getting distracted by superfluous stimuli nor being unable to respond when an

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unexpected but important matter calls for their involvement. Presence (some will colloquially refer to it as mindfulness) is equally characterized by a willingness to talk about hard past or future situations without getting stuck on these topics. Look for open body positions, soft eye contact, and supple physical stances. Listen for words that reflect curiosity or a willingness to suspend judgment of the situation. Examples in speech might include: • “It’s been like that in the past and who knows what it’ll be like this time around.” • “I’m pretty focused on my work, but I can take a break because this is important.” • “I notice how scattered I’ve been of late; I’m going to begin practicing mindful atten­ tion to what I’m doing.”

Inflexible vs. Flexible Perspective-Taking A technical description of inflexible perspective-taking with regard to the self is behavior framed in terms of a single view of one’s own behavioral repertoire without regard to contin­ gency demands of the current context. With regard to others, the same description can also be applied. In lay terms, referring to someone in terms of one quality and this one quality only, regardless of context, is inflexible perspective-taking. For example, a pilot is well described as such when flying a plane, but it would be odd to demand your husband and kids refer to you as Captain during a weekly game of Scrabble. It would be particularly odd if you could only talk about pitch, roll, and yaw when instructing a four-year-old to set a plate of cookies on the table for the family. Verbal tells to listen for include: • Referring to self or others as a “thing” (I’m a        ; she’s a        ) • Missing others’ points of view • Dismissing others’ points of view • Unsympathetic, harsh, or detached tone • Inability to respond to others’ pain, joy, and other emotional states To read poor perspectival flexibility, look for eyes that are averted or narrowly focused on a spot in the room while a person talks. The speaker with poor perspective-taking skills might alternatively talk to one person in the room, missing the opportunity to connect with others. You might observe a person with underdeveloped perspectival skills having a doe-in-the-head­ lights expression when others are sarcastic, deceitful, or bullying. Some attention to the ongoing stream of changing perspective is very healthy, but when a person’s perspectival skills are weak, you might notice them changing their point of view in a haphazard way, irrespective of the prevailing contingencies of reinforcement. Examples in speech might include:

ACT Functional Assessment and Functional Analysis49

• “I’m the peacemaker; my brother is the warrior.” • “It’s just my nature that I give in like that.” • “Look, I’m a lawyer. When I burn my lips at Starbucks, I immediately think in terms of litigation prospects.” • “Hey—you robbed me. That’s not fair!” • “I know; you’re upset. Now suck it up and go talk to your teacher about taking the test again.” The opposite of weak perspective-taking is seeing self in an ongoing way in terms of context. It is behavior with respect to self or others framed in terms of relevant antecedents and conse­ quences for behavior. In other words, Frank is Captain Frank when boarding the aircraft, but Uncle Frank when sitting down to a card game with his brother’s family on the weekend. Verbal tells include: • Recognizing features of one’s characteristic impressions of the world that are relevant or irrelevant in current situations • Acknowledging other points of view as valid and worthwhile • Encouraging others to give voice to their emotions • Responding effectively to kindness, warmth, affiliative humor, sarcasm, irony, deceit, bullying, and affectionate trickery • Tacting differences between I/here/now and you/there/then and shifting back and forth between these frames of reference Reading effective perspective skills in others includes observing a person shifting their conversational, humor, or argumentation style when they see others looking confused or uncomfortable. Matching voice volume, pitch, and cadence is a strong perspective-taking skill that you can test by matching yours to theirs and then changing yours to see whether the other person matches in kind. Empathetic listening, reflecting back what others have said, and non­ judgmentally offering a point of view while acknowledging other perspectives are all things to listen for in others’ speech. Use of descriptive and qualifying autoclitic frames is often at strength in the verbal behavior of those with advanced self-as-context skills. Some cues in speech might include: • “I see from your facial expression that you need further clarification on this.” • “It’s likely that they don’t see it this way, so we’ll need to be respectful of their views.” • “Gosh, that sounded very academic; let me try and rephrase that.”

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Loss of Contact with Values vs. Valuing Rigid or poorly articulated rules can govern behavior that contacts small, immediately available reinforcers at the expense of larger ones that require a bit more time or effort. Losing contact with or never fully articulating values amounts to cashing in early; it reflects a tendency to discount the value of delayed reinforcers. Unwillingness to delay gratification is correlated with poor life outcomes such as addictions and underemployment. Clear expression of things most deeply cherished and longed for is an important step toward staving off the effects of delay discounting. Some verbal tells to listen for are: • Being unable to tact the point, the meaning, the importance of events • Resignation • Failing to look at the bigger picture, the long-term prognosis You can read a person’s loss of contact with values in their insistence that this next goal, whatever goal that might be, is the big one, the one that will define success. (It never does.) The person without values may be doing a great deal, but when asked why, the response carries a bit of a shrug, a not knowing what for. There might even be a statement such as “because I have to,” but it is different from fusion to a rule that has to be followed, because without a values statement, there is no rule. If you have to do what you’re doing, you just have to without knowing the reason; this is in many ways quite the opposite of fusion, which involves doing things for a rigid reason that is clearly stated, even if it brings little contact with reinforcement. The tonal quality of speech inherent in resignation is often flat, the cadence underpunctuated. You may notice a labored weariness in the way a person moves when they have lost contact with what matters in what they are doing. Some examples in speech might include: • “I don’t see any point in this.” • “There’s nothing for me in any of this.” • “What’s the use?” • “I don’t know why I’m doing this, really.” • “I mean, I have to do this, right?” The flip side of a loss of contact with values is caring for a purpose—behavior under the control of well-articulated rules that are tied to hierarchically construed patterns of self-­ reinforcing actions. In other words, we define what Skinner (1953) could have termed appetitive self-stimulation in the form of self-praise and other verbal conditioned reinforcements when our actions comport with the criteria. The act of so defining what matters is valuing. Some verbal tells include:

ACT Functional Assessment and Functional Analysis51

• Distinguishing goals from values • Recognizing purpose in the experience of pain • Listing, journaling, or otherwise describing how you want to show up in the world, who you want to be for yourself or others You can read this in others who persist in a course of action or change what they’re doing in a way that is difficult for them, and when asked why, tell you clearly what the bigger picture or long-term goal is. The why is tacted with conviction; the individual who offers this kind of explanation for what they’re doing seems to be on fire with passion and resolve. Some examples in speech might be: • “It’s because I want to be able to play ball with my grandkids.” • “My relationship with my higher power is growing and changing; and one of the things I’m up to is giving back to the universe in simple, anonymous ways.” • “Sure, this is tough for me to do. But this is how I want to show up in the world.”

Aimless Behavior vs. Committed Action When behavior is aimless, it may contact reinforcers, but in a haphazard way and likely only the smaller ones that are immediately available, as opposed to larger, later ones. Aimlessness may be further characterized by inaction or a quality of behaving without reference to anything bigger than self at this juncture. Sometimes aimless behavior falls under the control of problem­ atic positive reinforcement that is immediate, such as drugs and alcohol. There is a nowness to this kind of behavior, but it is distinct from present moment awareness in that when one is present, the reinforcers result in health and vitality, whereas in problematic positive reinforce­ ment, the reinforcement may have immediate benefits but invariably leads to illness and defeat. Aimless behavior includes more than impulsivity. It also includes inaction, procrastination, and poor follow-through on commitments. Some verbal tells for aimless behavior are: • Doing what feels good in the moment, even if it is likely to result in problems later • Refusing to do something important because it would be difficult or painful You can tell when someone’s behavior is aimless because they are defiantly unwilling to do something that is important for them or others, or because they are doing things that do not seem harmful in the moment but have no long-term value and could result in long-term harm. You might hear a person hedging when asked to commit to something or apologizing without

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an excuse for not following through with a commitment. Some examples in speech might include: • “I’m not gonna.” • “You can if you want, but I’m just gonna do what feels good.” • “They’re going to put up a fierce battle against this. I know it’s important, but forget it. It’s too risky.” • “I will! I promise. Just not now. I don’t know when. Later, okay?” • “I’m sorry. I know I said I would do this. There was just a lot going on these past few days.” The opposite of aimless behavior is committed action, which is behavior closely aligned to hierarchically higher purposes; thus, although difficult, it is likely to contact larger reinforcers, even if temporally delayed. Some verbal tells are: • Raising a hand to volunteer for a difficult assignment • Persevering or changing tack when it is challenging but connected to a deeper meaning • Scheduling time to get things done • Evaluating potential barriers, generating and carrying out solutions • Developing and engaging in practices that improve skills You can read committed action in another’s behavior when you see them looking for things to do that align with their stated values and engaging in a series of problem-solving and contin­ gency management behaviors. You’ll see a person engaged in committed action self-monitoring and asking others to help manage their contingencies. They’ll either meet their goals in a timely fashion or take responsibility when missing a deadline and set new contingencies to improve the likelihood of their success on the next round. You do not see them sitting around for long once they have made commitments that are in sync with greater purposes, and if they hit a barrier they can’t work through, they ask for help. Their voice volume, cadence, and pitch shift with the situation and their conversation partner’s engagement. Some examples in speech might be: • “I’m on it; this is totally meaningful to me.” • “I’ve always wanted to get involved in something like this.” • “I’ll have this on your desk by Wednesday close of business.” • “What can I do right now? I’d like to get a jump on things because I know it’s going to be a long road ahead.”

ACT Functional Assessment and Functional Analysis53

Could Something You Scored as Fusion Really Be Something Else? Yes. Absolutely. So far, we have examined verbal utterances for their topography and tried to hypothesize the function. As I discussed above and as you know from your training in behav­ ior analysis, topographical information does not necessarily correspond with evidence gleaned from an experimental functional analysis. For this reason, we now turn to the brief ACT func­ tional analysis, one method for confirming or disconfirming the hypotheses you developed after examining topographical reads and tells.

The Brief ACT Functional Analysis Behavior analysts conduct functional analyses in analog situations with many populations, but most notably with young autistic kids who have high support needs. It’s a precise, quantitative effort to uncover the putative reinforcer or payoff for undesirable behaviors an individual con­ tinues to do. As I mentioned previously, thousands of studies and variations of this approach have been developed. In a way, functional analysis is like going to the doctor when you have an allergy. The doctor exposes you to allergens until one produces a rash; at that point, the condi­ tion that produces the allergic reaction has been identified. The needle pricks are aversive, but the outcome is that the doctor can treat the precise causal agent for the allergy. There are well-documented challenges in conducting functional analyses with severe inter­ fering behavior. The time required, resource and personnel costs, and potential for injury are burdensome. Even the most skillful presentation of the rationale for a procedure in which you produce aggression or self-injurious behavior may be difficult for stakeholders to appreciate. Even more importantly, because the analysis procedure may elicit strong emotions, the person­ nel conducting the procedure may become conditioned aversive stimuli. In small organizations where the functional analysis team are also therapists, without safeguards put into place, the therapeutic alliance between client and behavior technician may be weakened. A similar risk occurs in conducting ABA ACT functional analyses. The procedure involves asking a client if the way they have described their experience is accurate. This requires that you have built a strong therapeutic bond between yourself and the client. You begin by estab­ lishing yourself as a reinforcer. From there, you further identify yourself as a human being that stumbles, fumbles, and hurts like everyone else. If your client knows that you get stuck and that you yourself need to locate the source of your own suffering sometimes, they will likely trust that the questions you are asking will lead to healing and growth. The aim of a functional analysis is to uncover the consequences that historically have been afforded to a person when they’ve engaged in less desirable behavior. If you can figure out what the function of the behavior is, that is, what the payoff is for doing it, then you can cut off the reinforcer for this behavior and, instead, teach the learner a socially acceptable way to get the same outcome. These outcomes involve unconditioned and conditioned reinforcers.

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Motivating operations (MOs) are conditions of deprivation and aversive stimulation (or their opposites, satiation and appetitive stimulation). MOs have value-altering and behavioraltering characteristics. In other words, MOs change the value of a reinforcer and affect the immediate frequency of behavior that produces these reinforcers. MOs are subdivided into those that are acquired by the species between lifetimes and those that are learned by the individual within their lifetime. MOs that a species responds to after generations of selection are unconditioned. In contrast, conditioned MOs (CMOs) are learned within an individual’s lifetime. MOs are not things in the environment, nor are they behaviors. They are conditions that can be manipulated to either establish or abolish the effectiveness of a reinforcer. As such, according to Michael (1982) they are properly considered independent variables, useful tools to be worked with when targeting socially important behavior for change. Deprive someone of food and that is an establishing operation (EO) for eating because food deprivation increases the reinforcing effectiveness of food. Other EOs include intense heat, cold, salt deprivation, sugar deprivation, human contact deprivation, sleep deprivation, and so on. Satiation of these is called an abolishing operation, or AO. CMOs are those that are correlated with EOs and AOs through classical and operant con­ ditioning. CMOs are events that, after experiences you have with them, come to function as an unconditioned EO or AO might. The sight of a lock on the door to the beer cooler at the super­ market makes the cashier with the key a CMO. When you are beer-deprived, that cashier sure is important to you, and their presence immediately evokes you asking for their help. When you are not beer-deprived, the cashier doesn’t have this value- and behavior-altering effect. It’s very much in the moment. The MO construct is based on an analytic strategy for evaluating moment-to-moment rela­ tions between behavior and its context. This is important to understand. Arbitrarily applicable relational responding (AARR; Hayes, Barnes-Holmes, & Roche, 2001) does not necessarily lend itself to this kind of analysis strategy. AARR is a remarkably flexible capability that can produce stimulus relations (including those related to motivation) that last for a long time or that transform rapidly on the basis of verbal information—much more rapidly than direct con­ ditioning would allow. Here’s an example: Once you have quit drinking, seeing the cashier with the beer key might still have some of the same directly conditioned CMO effects as before. But through AARR, the function of this person begins to change. The change in this person’s function happens more rapidly than the direct conditioning. In other words, the presence of the cashier could elicit a cold sweat and increase the momentary value of opening the beer cooler, but given the motivational augmental, “Just for today, I’m not going to drink,” the function of the cashier changes from appetitive to aversive just long enough that you walk out the door and go on with your day, without beer. In other words, motivation in humans with verbal skill can persist or change on a dime in ways that are not well accounted for in direct contingency analysis of moment-to-moment

ACT Functional Assessment and Functional Analysis55

relations. We need a more molar account—an account that covers motivation that is tempo­ rally extended or constricted, disjointed, perhaps even detached, due to verbal mediation. There is nothing in the behavior analytic FA literature, or the RFT literature, that addresses the human aspirations that underlie fusion/defusion, EA/acceptance, conceptualized/transcen­ dent self, etc. We’re not there yet. However, Steve Hayes (2019) has recently advanced the concept of yearnings. It is unclear just yet whether this term will remain in vogue, but it is important in that it is an effort to capture the MOs that underlie each of the six ACT flexibility and inflexibility repertoires. The idea that under each of the six hexagon skills is an underlying aspiration helps lead to a technology that pinpoints exactly which individual skill or cluster of skills to focus on here and now. Understanding this gives you some powerful moves to make in session to bear out the specifics that will make a difference in the present context. Viewed as molar CMOs, yearnings can be understood for their temporally extended respon­ dent and operant functions. Of course, this is a nonmolecular way of describing CMOs. As such, it is an approximation that bridges the gap between existing behavioral terms for smaller patterns of behavior and broader, temporally extended behavior. Michael (1982, 1993) refined behavior analytic conceptualizations of motivation but main­ tained the molecular character of Skinner’s account. That is, Michael described operations for changing motivation on a moment-to-moment basis and thereby conceptualized motivation at a fine-grained level without recourse to cognitive or mentalistic statements. These were pivotal clarifications for which behavior analysts owe Michael a debt of gratitude. At the same time, some behavior persists independent of MO manipulation. Skinner (1953) addressed this when he described the way depriving a person of water could alter the function of water but fail to evoke drinking water that is available if the person suspects that it is poi­ soned. Such persistent refusal and other behavior that remains impervious to momentary changes in the environment may require widening the MO umbrella. ACT repertoires seen as responses to yearnings seem consistent with the notion of motiva­ tion as conditions of deprivation. When such repertoires are seen as needs that are learned during a lifetime and do not satiate quite the same way as other CMOs with momentary effects, behavior analysts may consider these aspirations molar CMOs. I have hinted at these in the sections above, but here is a brief list.

ACT Repertoire

Yearning

Explanation

Fusion / Defusion

Coherence

Meaning making, either through rules or through the examination of contexts in which rules apply or need to be altered

Inflexible / Flexible Selfing

Connection

Stories about who we are and, alternatively, taking others’ points of view serve to earn us a place in the group

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ACT Repertoire

Yearning

Explanation

Experiential Avoidance / Willingness

Feeling

Attempts to feel better and the alternative, to feel better, are each aimed at the yearning to feel

Loss of Contact with the Present Moment / Present Moment Awareness

Presence

Attempts to build awareness, either by an exclusive focus on the past, present, or future or by developing a mindful orientation to each in its due course

Loss of Contact with Values / Valuing

Purpose

Through compliance to essential, social, or functional values frameworks, we aim to locate purpose in life

Aimless Behavior / Committed Action

Competence

Habits, either those that are unhelpful in the long run or those that lead to purposeful living

You can touch on respondent and operant functions of these yearnings when working with a person in session. One method that I described briefly at the beginning of this chapter is to rapidly contrive a set of verbal abolishing and establishing operations. You will do this after first examining verbal tells and reads as described above. After that, the specific sequence to follow in the brief ACT functional analysis is: AO, EO, AO, and EO, arranged to elicit emotions and evoke overt behavior quickly, through which you have a relatively adequate, empirical handle on the function of that person’s behavior. Thus, the basic procedure is as follows: 1. Get consent to ask difficult questions. 2. Contrive an AO—validate the client’s experience. 3. Contrive an EO—challenge the client’s verbal description of their experience along the lines of one of the six ACT repertoires; this should evoke some protest and elicit some distress. 4. Contrive an AO—once again, validate the client’s experience. 5. Contrive an EO and a function-based treatment—continue to challenge the client’s description of their experience; again, if the hypothesis is correct, this will evoke some protest. However, this time offer to be there with the client, experiencing the difficul­ ties together and engaging in the difficult course of action by each other’s side.

ACT Functional Assessment and Functional Analysis57

Here is an example. In this vignette, a BCBA is working with the mom of a child with autism whose father is disinterested in contributing to their son’s ABA treatment. After listen­ ing for verbal tells and reads, the BCBA has hypothesized that this client’s behavior is fused to a rule that she has to be the problem solver. The molar CMO is coherence. Client:

We’re spinning our wheels. He should be at a different place, but here we are.

Client articulates problem.

Therapist:

To you, it’s simple. You have to move forward.

The therapist contrives an AO, aiming here to validate.

Client:

Yes! He needs to just see that.

The client relaxes, feeling validated.

Therapist:

And there’s every indication now that he won’t. He doesn’t think the two of you have to do anything. What’s that like for you?

The therapist contrives an EO, leaning in to evoke an escape response. Client stress and escape responses will confirm the hypothesized function.

Client:

I’m stuck in the mud.

The client acknowledges that this is stressful.

Therapist:

Revving your wheels doesn’t get you out of the mud. You spin, and your experience is…

The therapist contrives an AO, once again validating the client’s experience.

Client:

Right, my experience is that we’re even more bogged down whenever I push.

The client relaxes with the validation.

Therapist:

So maybe that’s it. You’re pushing the car. You’re accelerating the gas. And in the end, you’re getting nowhere. You know, I could run and get you some oil treatment and high-octane gas that you could put into this situation. Do you think that would help?

Here, the therapist contrives an EO with mild but playful sarcasm to elicit creative hopelessness. This will confirm the hypothesized function.

Client:

I guess not.

The client appears hopeless, resigned that what she has been doing has not been working.

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Therapist:

Yeah. And that’s what you’ve been doing, huh? You’ve been busy. And it makes perfect sense: there’s a rule out there—move your relationship forward. Seal this deal. Get it done. Is that the story you’ve been telling yourself?

Client:

I was taught that you have to be part of the solution or you’re part of the problem.

Therapist:

That’s the way the world works.

Client:

It’s what I was taught, yes.

Therapist:

And many things probably do work that way. Things fit inside that story. And the rule seems like it only makes sense if you’re actively pushing things forward. The problem is that your car is not on a paved road. Your car is stuck in mud. Pushing doesn’t work. Being part of the solution may mean doing something very different.

The therapist continues to evoke overt responses that flesh out the hopelessness of the client’s current repertoire.

The yearning for coherence is there inside both fused and defused ways of talking about what’s going on. It’s a motivation that is learned during a lifetime, passed on from others and by the establishment of verbal networks that help orient behavior rapidly in context. The brief ACT functional analysis here involves validating the client’s perception of the rule, then questioning the coherence of the story, then validating the client’s experience, then undermining the workability of maintaining the current understanding of the way to make sense of the rule in context. In technical terms, AO-EO-AO-EO is a withdrawal/reversal design, an ABAB design. It’s an FA strategy that you can use rapidly in session to determine whether your hypothesis about the functional determinants of the client’s behavior is important enough to develop an intervention. Here is another example. Once again, in a brief ACT functional analysis, the therapist contrives an AO, then an EO, reverts to AO, then back to EO, and tries out a function-based treatment. Here’s an example of the opening four steps in a vignette where the BCBA hypoth­ esizes that the client’s behavior is experientially avoidant. The molar CMO is feeling. Client:

It’s overwhelming to the point I can’t bear it any longer.

The client articulates a problem.

ACT Functional Assessment and Functional Analysis59

Therapist:

I can only imagine, with what you’ve just been through.

The therapist contrives an AO by validating the client’s experience.

Client:

It feels a bit silly when I say that to you, since we are here working together.

The client responds to the AO by softening.

Therapist:

Well, what if I were to tell you that it is going to be overwhelming, and you and I can walk through it together.

The therapist contrives an EO that, if the hypothesis is accurate, will evoke some minor protest.

Client:

The idea of walking through it feels like you want to push me inside a burning building. I can’t handle that.

The client responds to the EO by tightening up.

Therapist:

Oh my! I’m beginning to get this in a deeper way. For you, it’s not the feelings that you get when you’re alone. You can avoid them. It’s what shows up when we’re leaning in—here—together. That’s when it feels overwhelming. Pushed. To where it’s too hot.

The therapist again validates the experience of the client, thereby contriving an AO.

Client:

I want to press through. I’m just…

The client responds by softening, and there’s a recognition that is forming here, but it’s not yet forming into words.

Therapist:

The other side of this burning building, this overwhelming heat. What’s there for you? On the other side?

The therapist is beginning to uncover a function.

Client:

Air…light…breathing.

The brief ACT functional analysis is complete when the client articulates their deeper yearning, which in this case is the feeling of seeing the light and being able to breathe. The next step is to develop a very brief, function-based in-session ACT intervention. If it gains traction, a more fully developed intervention can follow.

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As described above, the basic procedure is as follows: 1. Contrive an AO—validate the client’s experience. 2. Contrive an EO—challenge the client’s verbal description of their experience; this should evoke some protest. 3. Contrive an AO—once again, validate the client’s experience. 4. Contrive an EO and a function-based treatment—continue to challenge the client’s verbal description of their experience; again, if the hypothesis is correct, this will evoke some protest. However, this time offer to be there with the client, experiencing the difficulties together and engaging in the difficult course of action by each other’s side. Another example of using functional analysis for loss of contact with the present moment is available on the website for this book at http://www.newharbinger.com/45816. One last word of caution regarding ABA ACT functional analyses: if your client responds to the EO you have contrived without showing signs of stress or pushing back against the idea you are suggesting, lean in further. If your client continues in the same vein, two things are possible: 1. Your client is an ACT rock star and wants to succeed badly enough to risk experienc­ ing pain. 2. Your assessment of function was off, and it would be good to listen for other verbal tells and reads, after which you might follow up with another brief ACT functional analysis. In recent years, behavior analysts have been asked to reflect upon practices that appear cold to those we serve. It is possible that the brief ACT functional analysis procedure described above could devolve into an insensitive and unkind procedure. Below are some guidelines for infusing kindness, vulnerability, and self-disclosure into the assessment process.

Kindness, Vulnerability, and Self-Disclosure During and after the above procedures (listening for verbal tells, looking for reads, and con­ ducting a brief ACT functional analysis), should you be successful or completely unable to confirm your hypothesis, it is good to evoke a wide cross-section of relational framing behaviors. The deeper behavioral and symbolic functions of events for which you are assisting a client may be difficult to uncover, so it is important to know a bit about relational framing as you under­ take the assessment process. It’s a bit like driving a car. Usually, it’s enough to know how the wheel, gas, and brake pedals work and how to read the speedometer. But there are times when the car stalls out on the road. At these times, it pays to know how to pop the hood and look inside.

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For starters, it is important to bear in mind that your services are required because some­ one—a parent, a child, an employee, a supervisee—is having a hard time. Your expertise as a behavior analyst is summoned when someone is struggling. The vulnerability they experience in coming to you for help is matched only by the lengths they will go to save face and look good in the context of your work together. In short, asking for help hurts. It adds pain to pain. It is natural for clients to try and airbrush the image they are painting for you, to keep you from judging them and to avoid feeling here what they are already feeling there. The italics I used in the previous sentence are to underscore an important point: functional assessment requires a client to allow the reality of their experience in the world into the room that you share with them. If their experience is grim, you need to know it. If they experience everyone in their midst threatening them, you need to know that too. The AO condition I described above is only the beginning of validating your client’s experience. If you are not gaining traction in your assessment, it may be useful to take a step toward greater openness in the room by disclosing your own difficulty in the matter. You need to make certain that your client experiences you as an ally, a nonpunishing audience, as Skinner (1953) wrote, whose heart skips a beat at certain memories, whose blood races to your face when you are feeling exposed, whose hurts are raw, and who is not always sure which way to go. The openness you create by being a human in the room is the difference between being a technician who takes down a history and a healer who treats human behavior of all kinds, including that which is most private and hidden, with the deepest sensitivity and kindness.

Assessing Relational Framing Repertoires A client may not be forthcoming as to the symbolic function to them of a verbally related life event. Take, for example, a child in transition whose classmates mocked them with a demean­ ing nickname. They may beat up one of the bullies, after which you are called to assess the child’s behavior. If they experience you as a threat, they will likely shut down in front of you. But if they experience you as a helper, they may fear themselves around you—because what if they open up, lose control, and start crying? Historically for them, it has only gotten worse from there. That may be how the taunting began in the first place. From their perspective, they can’t allow that to happen again. As it turns out, this situation is not uncommon when assessing indirect-acting verbal func­ tions. Many clients shut down and sanitize their experiences to keep what they experience out there away from here. In these situations, it is useful to think of a door with three or four locks that must each be opened separately to gain entry to the house within. Each lock is different, turns a different way, and has its own set of unique tumblers that must be unlatched in particu­ lar ways. One way to approach these locks is by asking the client to try working a series of keys comprised of relational framing questions.

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Coordination Asking questions about the way that being here is like being there is one way to begin. “I imagine that in some ways, for you, I’m a lot like they are. Can you tell me how I might be like they are for you?”

Distinction The answers to the question above may lead to using the next key on a second lock. “So, I’m not exactly like them. In what ways am I different from them to you?” or, “In what ways is this situation different from that one?”

Analogy Even if the door is beginning to loosen, a number of other locks may be keeping you from generating an open rapport where the symbolic functions of the events in this person’s life become available for your cooperative inspection together. Asking the client to consider rela­ tionships between relations is another lock to open. “If in this way I am like them to you, and here, you react in this way, how might you be acting out there that is producing the very same outcome?” An important outcome of this kind of question is that the client may begin to tact their issues in terms of behavior that they can change and monitor what others do in return.

Opposition Humans readily relate events in opposition to the ways that they initially learn them. A child hears that she is bad, and she thinks to herself that she is trying to be good. At times when framing in opposition would be beneficial, a person may not do so, yet asking questions about opposite relations can help them behave more successfully. “If this has been getting you this outcome, what might need to change to get you that outcome?” or “In the past, before this started, in what ways did you act that got the opposite of this?” When oppositional framing is jump-started, clients articulate the conditions under which they are not so stuck. Functional assessment is now in full swing.

Conditionality If-then relations are important framing repertoires that provide additional dimension to one’s assessment of their experiences. Many rigid evaluations can be softened when framed conditionally. “It’s not that I’m tense, it’s that if you push me to give you an answer before I’m ready, then I tend to behave tensely.” Note the skill with which this speaker transforms another

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person’s reified personality evaluation from its noun form to an adverb, suggesting that being tense is a behavior, not a static state of being.

Hierarchy Questions that lead to an evaluation of the aspects of one’s experience that are part of something larger can be quite helpful for recategorizing aversive and appetitive experiences. “So, here, you’re finding that these three things are needed for that to happen. Out there, it seemed like only one thing that you did was needed. But then, you didn’t really get what you truly yearned for, did you? I think that’s why we’re working on this now, because in some way what you did worked, but in other ways, it didn’t work so well. Now I’m really curious, what are the necessary ingredients for that thing you want to happen? How might we try and untangle this?”

Temporal and Spatial Relations Other framing repertoires that build on or extend beyond direct contingencies are also useful to explore. “This is what happened then. Would this happen again now, or would it be different, now that you are older and bigger?” or “That’s what happened when you were there. I’m wondering if there are some small ways we might identify that it happens differently here.” There is a pattern emerging in the questions I’m suggesting that you ask. Each one is intended to generate relational responding that juxtaposes an existing symbolic function to alternative ones. By working through questions such as these, the hidden functions of verbally related experiences begin to unfold.

Deictic Relations As discussed in chapter 1, deictic relations are different than the others in that the conflu­ ence of I/here/now and its relation to you/there/then is not built on top of direct contingency learning, but through verbal learning built on top of other verbal learning. In other words, only after learning that here and there are distinct, and that now and then are distinct, and that I and you are distinct can these sets of relations be put together in unique ways to promote a sense of identity, perspective, and understanding. In fact, it is exactly this kind of understanding that you must begin with and that your client should come to discover through your work together. Whether it is understanding their tormentors in school, their child’s aggression, or their own difficulties with conducting ABA with a child, it is understanding of self in time and space that makes possible the transformation of symbolic functions to promote effective action. Questions such as “If she were here, what might she say now?” and “Imagine yourself there then; how might you be reacting to this same situation?” evoke deictic framing to shift the focus from an undifferentiated “I” to an “I-in-context.”

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The importance of an assessment of “I-in-context,” or the deictic-I, is that this is the start­ ing point to examining the relations among relationships a client has to • their identity in current contexts (I/here/now) compared to different contexts (I/there/ then), for example, “I’m weak, but I used to be strong” • their multiple identities that are ununified in current contexts (I/here/now and a dif­ ferent verbally defined I/here/now), for example, “I’m a good reader, just not a good writer” • others’ identities examined in various contexts (they/here/now and they/there/then), for example, “They’re vicious now; they used to be gentle” Skinner (1953) suggested that humans have multiple selves, or repertoires, that are merely patterns of behavior under the control of different variables. A person who burns calories very rapidly and is frequently seen eating is said to be a hungry individual. Another who has repeat­ edly been punished unfairly in a school setting may appear, in that setting, to be an angry person. The RFT analysis of multiple deictic-I and deictic-other relations furthers Skinner’s analysis by identifying the conditions under which a person whose identity is determined by such circumstances might gain perspective of broader contextual variables governing these seemingly disparate views of self and other. This enlarged perspective is the locus from which an individual can be taught to manipulate variables affecting their behavior to produce a more integrated and effective identity in context. I will address how this is done during treatment in other chapters, but the verbal functional assessment described above may be briefly illustrated with the following case example. Max is a twenty-eight-year-old mother whose son Julian is autistic. For weeks at a time, Max completes ABA assignments dutifully with her son, but then there are weeks when she does not, and the BCBA working with her is trying to uncover the sources of variability in the data. In this, the BCBA learns that Max is frequently called “lazy” by her husband when he comes home to find dinner unprepared and their son’s toys strewn around the living room. As a result, this word “lazy” and all such words with coordinated functions are aversive for her. Since Julian’s birth and subsequent diagnosis, Max has poured herself into motherhood to the extent that her husband and family refer to her as “devoted” to her son. As you might expect, “devotion” and motherhood in general carry appetitive functions for Max. She is framing herself as simultaneously devoted and lazy, and the apparent contradiction between these labels serves to concurrently evoke framing herself in opposite ways. The resultant confusion to her is unmanageable and leads to the oscillating pattern of engagement in ABA work that the BCBA is observing. Here, as in so many other contexts in which behavior analysts support parents, DCM variables are unavailable for manipulation by the analyst. Thus, ACT, or an applied RFT approach, would be useful in this situation. To that end, functional assessment of the “lazy” deictic-I in contrast to the “devoted” selfrepertoire can be done using the brief ACT functional analysis procedure described above,

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paying particular attention to opportunities to validate Max’s reaction to the “lazy” label. The BCBA working with Max could say something like, “I hear you questioning yourself about how good a partner you are to your husband, and that seems perfectly natural to me. Anyone ‘devoted’ to being a good mom would ask themselves, ‘How could I be so forgetful about clean­ ing up or be so slow at getting dinner on?’ when called names by a partner.” The BCBA focuses this way on the appetitive “devoted” deictic-I to evoke more engaged responding from Max. This would be followed with an EO, something like, “And I want to challenge you a bit here. Is it possible that you are ‘devoted’ and that as a consequence of devoting yourself to your child’s welfare, other things to which you might allocate time do not get the same level of attention? If you agree, then my challenge is this: can you imagine yourself as you are, devoted to your son’s well-being, having a conversation at some point with your husband about sharing the load with you?” This is expected to evoke an avoidance response from Max that is the empirical verifica­ tion of the hypothesized deictic function. This EO condition would then be followed by a second AO, in which the therapist again positions themself alongside Max as an ally who would have the same reactions. “I fully appreciate how frightening that prospect is. I would be unsure of myself having that kind of interaction with my partner.” During the final EO condition, the complexity of an RFT analysis of relations among rela­ tions is established. Specifically, the BCBA might frame a conditional deictic-I by saying, “Max, maybe you can move toward being devoted-with-help.” Here, the BCBA would be suggesting that being devoted is conditional upon getting help with other aspects of family chores. Being devoted is unsustainable without a balancing input of help from somewhere else in the family system. There is only so much time in the day, and Max can only run the ABA sessions that the BCBA is prescribing if her husband helps with some of the evening routines. Thus, the BCBA might continue, “But here you are; you are devoted to doing the ABA sessions that your son requires. That takes time away from other family routines. The discussion I’m suggesting might be useful, though of course, I cannot know for sure. But it’s clear to you now that getting things done with Julian seems more important to you than getting other things done for your husband, and that may not be unworkable for the three of you. It might be worth discussing, maybe over tea and dessert at a time when you and your husband are both relaxed and comfortable with each other.” Once the conditional deictic-I is firmly established, the BCBA has completed this part of the functional assessment and is prepared to develop an intervention. Of course, here it is also possible that Max would in turn talk about her husband as “busy” and her mother as “available.” Discriminating the network of relations between devoted-withhelp Max, busy husband, and available mother is the next step. You might be wondering whether all of this is possible to do merely with reference to the six hexaflex repertoires described earlier in the chapter. Absolutely. Many ACT practitioners never go beyond the “middle-level term” analysis of function. There may be no need, if you are adept. The point I am making here is that RFT is the engine under the hood, and should the therapy vehicle you’re driving stall out along the way, it’s good to have an idea what you’re

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looking at if you need to pop the hood. That way, you can make efficient, precise adjustments to variables that will likely get the vehicle back on the road.

Relational Framing with Young Children Variants of all of the questions posed above can be constructed with young children, pro­ vided they have a minimal verbal repertoire and that you create a rich context in which to imagine answers to the questions you pose. Similar to an adult who does not feel safe enough to directly answer questions you pose related to their verbal tells, children may not understand any of these questions unless you create a rich metaphorical context in which to imagine them­ selves. Discussing fantasy people, dolls, and characters a child has drawn on paper can open the locks to help you functionally assess the material behind a child’s closed door. Your creativity is needed to build these contexts. Fortunately, most children will gladly invite you into their fan­ tastic worlds; you have only to accept their leads.

Assessing Essential, Social, and Functional Coherence If you have identified fusion or loss of contact with values as important barriers to client func­ tioning, it is further useful to uncover the extent to which their verbal rules are constructed around precepts that the client sees as universal and unbending, and the extent to which the rules they hold tightly are social in origin. Behavior that serves to cohere with essential rules is particularly inflexible and prone to producing pain if contingencies in a changing environment support dynamic over static kinds of responses. Helping clients tact these essential coherence functions is important to their making decisions to keep them and accept the accompanying private experiences or change with shifts in the direct contingencies of reinforcement. Some questions to ask could be, “Is this the general way of things, in your view, the way things are supposed to be?” or “You seem to hold this up as a kind of model, the foundational rule under which you operate. Is that right?” Behavior that coheres with social rules tends to be more flexible but may still be rigid if social orders tend to verbalize strict codes of conduct. Individuals who maintain the façade of adherence to social rules do so at the expense of personal integrity, whereas those who buck the social rules risk being ostracized or otherwise sanctioned. Clients with a clear and unsanitized view of those who stand to gain from their adherence to these rules can make healthy choices as to whether to stay in the social circles that enforce these rules or move to circles that support other kinds of behavior. If you suspect social coherence to be constraining your client’s effective action, you might ask, “Your group seems to dictate this course of action, and yet you struggle because it’s not what you want to do. Is this group important enough to you to squelch your

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personal longing, or are there other groups that you might search out where the direction you’re leaning would be more welcome?” When behavior shifts to being defused from tight blinders, the likely outcome is a shift toward functional coherence. When behavior serves to cohere with functional rules, the rules themselves shift to support responses that are most likely to contact positive reinforcement in ways that do not threaten to undermine an individual’s relationship with themselves in that context. In other words, behavior guided by functional coherence is at once values based, defused, and guided by a view of self that is responsive to changes in the environment. To check whether this is the case, you might ask, “You seem to have found a way to connect with your values, you’ve developed a few codes of conduct for yourself that seem to fit the circles you’re operating in, and yet when it’s hard, I’m seeing you being gentle with yourself and others. Do you see the changes you’ve made this way, or are there things that still do not quite fit for you?”

Assessing Plys, Tracks, and Augmentals Additional considerations come to bear when you identify that loss of contact with values is constricting a client’s repertoire. As described in chapter 1, rule following is typically learned in three stages, only the last of which involves the construction of rules for living that work in context. When a person is following rules due to a history of social approval for doing so, their rule following is said to be a ply. Pliance is, of course, quite useful and important, but overextended, it leads to disproportionate shares of positive reinforcement going elsewhere. Pliant behavior may contact social positive reinforcement, but unconditioned reinforcers do not necessarily follow. When a person’s behavior is out of synch with their values or they have not identified values by which to live, overextended pliance should be evaluated as a source of the problem. One way to assess this is to ask, “Is it your understanding that this rule goes for everyone at all times and is not something that should be questioned?” or “It makes sense that you act this way; you hold it as a given that the rule is set and it’s your role to follow it just this way. Do I have that right?” Alternatively, following rules due to a history of positive outcomes for following rules can be an effective strategy for acting, but like plys, overextended tracking can lead to behavior that worked in other contexts but not in the immediate surroundings. This can be assessed with questions such as, “Following your dad’s rules worked well for you at home and in high school. Am I right in saying that you’re noticing the same rules aren’t as workable in your new job?” Helping a client without grounding in their values uncover overextended tracks easily leads to their generating new rules that are consistent with their values. These formative augmentals can very rapidly become motivational phrases, verses, or even images that help orient a person to behavior that helps them be who they wish to be in the world. For example, you might help

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a child develop an augmental for their engagement in gym class by asking, “Is there a superhero you know who was weak before they started exercising? Would it help to put a sticker with an image of them in your locker at school?” The assessment is complete when the individual tact contexts in which one motivational augmental will work to produce this behavior that leads to a particular reinforcer, in contrast to different contexts in which another augmental will evoke alternate behavior that contacts reinforcement.

CHAPTER 4

Learning ACT: A Three-Stage Plan

Applied behavior analysts receive training in a variety of techniques that range from highly prescriptive (e.g., discrete trial training) to moderately flexible and creative (e.g., natural envi­ ronment training). When ABA tutors and aspirant BCBAs first develop their craft, they are often taught in a sequenced fashion that progresses from easy to difficult. The development of a versatile repertoire involves mastery of many different tools and strategies, each of which may be applied in unique circumstances. In this chapter, I present such a graduated training plan for learning to implement ACT with contextual sensitivity and creativity. I briefly discuss three tools to be mastered before teaching clients to use each of the six ACT repertoires. I will develop and provide learning exercises in the subsequent chapters, but here I introduce them from those that are easiest to those that are most difficult to master. These three tools are the ACT matrix (chapter 5), metaphors (chapter 6), and active exercises (chapter 7).

The ACT Matrix Learning to read deficits and excesses in a client’s six ACT repertoires is challenging to begin­ ning ACT practitioners. Moreover, relating those in a client’s to one’s own repertoire deficits and excesses is remarkably complex. An advanced ACT practitioner might fine-tune this assessment by recognizing weaknesses in a client’s and one’s own relational framing and rulefollowing repertoires. An advanced practice makes use of all these tools in a seamless, effortless manner. Learning all this can seem quite daunting, to say the least. On top of this, for the BCBA there is an additional skill set that needs to be honed: that of staying within the behavior analyst’s scope of practice. Where do you begin? Fortunately, you are not the first to have asked this question. Kevin Polk became curious about this over a decade ago. Interested in developing a simple way to teach new practitioners to assess and intervene using the ACT model, Polk and Schoendorff (2014) began playing around with a grid onto which to map ACT processes. After numerous iterations, they settled on the use of a Cartesian plane drawing with four quadrants (see figure 4.1). They played around with numerous names for the grid, the first of which was the ACT grid. Pretty uninspiring.

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At some point, someone called the grid a matrix, and the term ACT matrix was born. Of course, there is no good explanation for what that word in this context actually means. Matrix? Why matrix? The answer is that, well, The Matrix has Keanu Reeves cool written all over it, and so that’s the name that stuck.

Figure 4.1 The matrix is drawn with two intersecting lines and a circle in the center at the point of intersection. In the upper quadrants, observable, measurable behavior is listed. The lower quad­ rants are used to list covert behaviors (see figure 4.2). On the left half of the matrix, negatively reinforced behaviors are listed. On the right half of the matrix, positively reinforced behaviors are detailed (see figure 4.3). Thus, the lower right quadrant is a list of private behaviors that are under appetitive control. These are commonly referred to as values, the things a person cares most about inside their relationship with their job, a loved one, or a group they work with. A simple way of talking about these values is to say that this is a list of the ways you want to show up and be with this job, person, or group. Common examples of values might be “being the best BCBA I can be,” “working effectively with all my colleagues,” or “being empathetic with my child as she struggles to learn.” The lower left quadrant is also a list of covert behaviors, except these are private responses that get in the way. The common way of discussing this is to say that this is a list of emotions, thoughts, memories, and bodily sensations. Private events such as jealousy, resentment, fear, memories of previous betrayals and abuse, chronic pain, fatigue, and lack of stamina are fre­ quently listed in this quadrant.

Learning ACT: A Three-Stage Plan71

Figure 4.2

Figure 4.3 The upper left quadrant of the matrix is a list of overt behaviors that the individual or group can be observed engaging in. Typically, these are negatively reinforced behaviors. That is, they are behaviors that in the past resulted in the avoidance or termination of aversive events. Shouting, glaring, giving the silent treatment, arguing, threatening, hitting, handing in late assignments, ignoring, avoiding eye contact, and making excuses are examples of behaviors that individuals and groups often list here. Often, therapists describe these as “away” moves in that they move a person away from their values.

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In the upper right quadrant, learners and therapists list behaviors that others have seen in the past or would see if they were behaving in accordance with their values. Often, these behav­ iors are met with positive reinforcement or at least appetitive consequences in the way of social approval, favorable performance appraisals, and promotions. Examples of the behaviors listed in this quadrant might include smiling, making eye contact, cheering on colleagues, offering to compromise, saying hello, asking polite questions, trying difficult tasks, collecting data, asking for help, and asking for attention. In contrast to the upper left quadrant behaviors, these are often described as “toward” moves, in that they move a person closer to their values. One of my students worked with her daughter and developed this example of a matrix for engagement in a team sport (see figure 4.4). Note the use of arrows connecting aversive private events to measurable, observable behaviors that she engaged in. This illustrates one of the ways the ACT matrix can be used to help individuals set goals and self-monitor. My student contin­ ued to use this format but asked her daughter to put dates and times next to the occurrences of unwanted private events and the overt behaviors she engaged in.

Figure 4.4

Learning ACT: A Three-Stage Plan73

In chapter 5, you will learn other ways to make use of the ACT matrix with young children as well as with adolescents and adults. For now, it is enough that you have a sense that the matrix is a flexible instrument that is useful in both assessment and treatment of challenging behavior in which derived relational responding plays a role.

Metaphors You learned in chapter 1 that Skinner claimed that the powerful way a metaphor evokes behav­ ior change is by abstracting a tact on the basis of common physical properties. Told that “Highway 61 is a gravel pit,” a listener will respond to the extended tact of the highway’s physi­ cal features and likely search for an alternate route. RFT suggests that extending tact relations on the basis of nonarbitrary dimensions is a necessary condition but not sufficient in itself for generating the kind of abstraction that leads to effective action. Imagine working with a child who has experienced the frustration and joy of trying to get out of a Chinese finger trap. You can tell this learner that trying not to think about something is like getting stuck in a Chinese finger trap and the child will respond rapidly to the common properties of trying hard and getting more stuck in contrast to letting go of the struggle to slowly get free. But this is not likely the end of the child’s derived relational respond­ ing. He may also derive that trying too hard is dangerous when telling jokes to friends and going on dates. If (A) trying hard not to think about something is equal to (B) getting stuck in finger traps, the child could subsequently derive that (A’) any kind of trying too hard will definitely result in (B’) all kinds of getting stuck. The transformation of stimulus function is carried into additional Cfunc networks (different experiences of being thwarted) due to a history of training and reinforcement in other Crel classes (frames of hierarchy) and further cemented into place with a qualitative autoclitic (definitely serves this function). This can be beneficial in some cases, but a skilled practitioner should be on the lookout for overextensions that are no longer healthy, such as if the learner were to equate (A’’) trying hard in math or physics as being certain to result in (B’’) getting stuck. That responding of this sort can be an issue at all reflects the RFT prediction that metaphor does not by necessity rely upon abstraction of common physical properties; instead, the common properties may be arbitrary and thus applied in any direction, forward or back. In a review of the literature on metaphor use in education and therapy, McCurry and Hayes (1992) suggested that to be helpful, metaphors should have commonsense appeal, evoke a rich sensory response, contain elements that mirror the client’s situation, be broad enough to capture a range of circumstances, but not be so general as to be inapplicable to a specific context. In the highway–gravel pit metaphor, the commonsense quality of a gravel pit being undesirable pro­ vides relevant data about the road and serves as a guide to action. The comparison of a poten­ tial travel route to a rough, open mine elicits tactile sensations that are undesirable and evokes the behavior of seeking other passageways. The gravel pit metaphor becomes most relevant if

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the listener has driven on objectionably rough roads before and is motivated to drive along a less jarring route. There are classic ACT metaphors such as the Chinese finger trap and quicksand, which are established as analogous to the pitfalls of trying not to feel bad or think about things that are hard. But a BCBA working for many months or years with an individual is not likely to be able to make use of either of these metaphors more than a few times. Fortunately, everyday speech is laden with rich pools of metaphor that can be used on the spot as they are emitted. For example, in the above paragraph I referred to two metaphors that reveal the pitfalls of certain patterns of behavior. I went on to write of speech that is laden with metaphors that are found in rich pools within common everyday discourse. Any one of these metaphors can be captured in flight (note the metaphor) and harnessed (another one) for clinical purposes. To make clinical use of a metaphor pulled from speech, it is important to have done an ACT functional assessment (chapter 3). If you have identified experiential avoidance as an ACT target for Pam, an individual who says her son’s cries are like fingernails raked along a chalkboard, you might ask her to verbally describe the length of the fingernails that would produce the most painful sound. Then you might ask Pam to imagine the chalkboard in this room, here and now, the color of the board, whether it has a wooden or metallic bezel, and whether there are words written on the chalkboard that she can read. Ask her to write down what she is feeling about her son’s crying as she imagines these nails against the chalkboard, then ask her to share with you what she wrote. The commonsense metaphor that Pam used is now being employed to evoke a sensory response that can be tied in a precise way to her experi­ ence of her son’s cries. The next step is to ask Pam if she noticed that she has been contacting the nails on the chalkboard for some time, describing it, writing about it, and sharing what she wrote with you. She has been contacting the aversive stimulus without respite. Given that she cares deeply about her son’s learning, ask if there is anything about this experience of nails against the chalkboard that she absolutely cannot have. You are asking if Pam is willing to be uncomfort­ able in service of her deepest hopes and dreams for her child. All of this came from a single utterance she offered in passing that made for an in-session intervention that could then be migrated into a home-practice activity. For example, Pam can be asked to spend five minutes each afternoon before her son comes home imagining herself listening to the nails on the chalk­ board, waiting until there is a break in the sound, and then wiping down the board with a soft felt eraser. This is a process intervention, and like other self-management procedures, she can be taught to take data on her completion of this task. Repeated process interventions involving metaphor ought to be followed by context interventions. In this case, sitting down to ABA practice with her son, setting daily duration goals, and measuring the daily temporal extent of her engagement could be a useful next step. In chapter 6, you will learn more about catching and using metaphors within a typical ABA session. At this point, we turn our focus to a brief overview of the use of active exercises to enhance the behavioral impact of metaphors related to functional classes of unworkable behavior.

Learning ACT: A Three-Stage Plan75

Active Exercises Oftentimes, commonsense metaphors that elicit a rich sensory experience similar to a client’s circumstances will not evoke desired behavior outside of session when this would be most ben­ eficial. In order to improve the likelihood that a client will make use of the metaphor when it counts, it can be beneficial to physicalize it in session with the client. This enhances the sensory experience of the metaphor and makes the session more actively behavior based. For example, to strengthen the discriminative function of a metaphor regarding the pitfall of trying not to feel bad, you could ask a client to walk across a series of small stools that get progressively farther apart from each other. At some point, the client falls into “the pit.” To illustrate the dif­ ficulty of climbing out of the pit, ask the client to sit cross-legged when trying to get back on top of a stool. In contrast to trying not to fall in and then trying to climb out, ask the client to actively step from the stool into the pit and to sit down cross-legged as before, but rather than struggling to get out of it, instead suggest the client find a way to move across the floor toward something of value. Because it is funny and animated, a physicalized metaphor of this kind is highly likely to cue desired behavior outside of session even if the client never engages in a process-based homework intervention related to the metaphor. Probably, the ACT practice of active exercises such as the one above originated in experi­ ential gestalt therapy preparations. The brand of active exercise that I will introduce in chapter 7 comes more from the theory and practice of outdoor adventure therapy (Gass, 1993; Schoel, Prouty, & Radcliffe, 1988). Adventure therapists use activities with high levels of perceived risk and low levels of actual risk to create contexts for learners to try novel behaviors and then discuss the way they might try to take similarly challenging but healthy risks in daily life. Activities such as rock climbing, rappelling, and orienteering are often used to simulate life situ­ ations where getting unstuck involves trying to move even when frightened, communicating with others, extending trust, or taking responsibility for another’s safety. ABA practitioners are not likely to have the repertoire or resources for outdoor adventure activities. However, it is possible to make use of bandanas, kernmantle ropes, rubber therapy bands, plastic mats, cones, hula hoops, and other items found at the dollar store to produce highly evocative, memorable active exercises that are set up and debriefed to promote the use of ACT repertoires in session. In this way, a BCBA can create adventure in the classroom or home. Active exercises can be contrived for individuals, dyads, small groups, and large groups. For example, behavior technicians who have been trained and shadowed may be nervous that they are not ready to go to a client’s home and implement programs without a supervisor there to prompt them. The thought of being an imposter can be overwhelming and can produce the context in which the interventionist actually does make errors. To help newly trained tech­ nicians through this, you could offer this active exercise: You know, I can recall being at the point in my training that you are in yours. It was terrifying. My supervisors thought I was ready, but I just knew I wasn’t. I knew that I was a fraud and that the parents of the kids I was getting sent out to work with would

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know it immediately. Since you’ve shared with me that you feel this way, I’m going to ask you to do a little active exercise with me that might shed a new light on your situation. I’m going to ask you to partner up and I’d like one person in each pair to close your eyes. I’m going to ask your permission to blindfold you, too. Partners, if your buddy with closed eyes agrees, go ahead and blindfold them. Next, if you are the blindfolded person, I’d like you to fold your arms across your chest, lock your knees and hold them tightly together, lock your ankles together as well, and stand as straight as you can. Partners, I’d like you to stand behind your blindfolded buddy’s back and ask their permission to touch their shoulders. If you are given permission, put your hands on their shoulders, take a step back, and remove your hands from their shoulders, but keep them suspended in the air nearby. Blindfolded folks, when I count to three, I’m going to ask you to fall back into the arms of your partners, who are there to have your back, to spot you should you need them. And you will need them, because you are going to fall into their arms. After the first round, you can ask the spotter to take another step back, increasing the behaviors of trusting the spotter and responsibly securing another’s fall. Afterward, debrief how it felt to fall and to have another be there to help you when you faltered. Relate this to going into a client’s home without a supervisor present and to being able to phone the supervisor when needed. The varieties of active adventure exercises and physicalized metaphors are endless. You can learn to conceive these in the moment after having tried a few classic exercises. As with meta­ phor construction, the important features are that there is a commonsense story or metaphor that elicits rich sensory experience, is easily relatable to the client’s life circumstances, and is interpretable in ways that are neither too broad nor too narrow. In the following chapters, I will present more specific guidelines and tie active exercises to catching metaphors and using the ACT matrix.

CHAPTER 5

The ACT Matrix: A Launchpad for Other Activities

In chapter 4, you learned the basics about the ACT matrix. Plainly, the matrix is an assessment and intervention tool that makes use of a Cartesian grid to highlight private versus public behavior maintained by either positive or negative reinforcement. There are at least two booklength treatments about ways that mental health practitioners, trainers, coaches, health workers, and community activists make use of this technology (Polk & Schoendorff, 2014; Polk, Schoendorff, Webster, & Olaz, 2016). These books are excellent, and I will not try to recreate them here. Rather, in this chapter, I will teach you the basics for using this technology within the settings and situations most common to applied behavior analysts.

The Matrix Distinguishes Negative and Positive Reinforcement Contingencies Broadly speaking, the ACT matrix is a device that distinguishes appetitive from aversive behav­ ior. That is, the right and left sides of the grid are used to assess negative and positive reinforce­ ment contingencies and identify behaviors an individual engages in during each of these operations. Proficient use of the matrix underscores the way individuals dismiss reinforcers they must wait for, even if these would be higher magnitude reinforcers. Negative reinforcement and experiential avoidance are fast-acting and certain, compared to the delayed and uncertain positive reinforcement that results from more effortful behavior. Just think of how unquestionably easier it would be to close this book right now and avoid the work involved in reading it compared to laboring on and completing the exercises that for the most part ought to, but will not with any certainty, lead to being competent at ACT. As an intervention tool, the matrix can be used to discriminate helpful and life-affirming aversive behavior from that which narrows life to a very small cluster of activities that avoid any events with symbolic functions related to previous experiences of pain. The practitioner uses the matrix as a springboard for practicing difficult repertoires with a limited history of paying off. By offering immediate social praise for within-session and homework efforts, the analyst

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begins two operations. First, praise for trying novel behavior builds new response functions for these difficult appetitive behaviors. Second, this procedure forms new layers of stimulus func­ tion to the situations that have in the past acquired aversive symbolic properties. The metaphor of a springboard for the action of the matrix is helpful. Imagine sitting at the edge of a cold glacial river pool beside a bank of snow in the mountains after an exciting but strenuous hike. You could dip your toes in and gradually immerse yourself, but the slow accli­ matization would take a long time, and by the time your whole body is in the water, your toes might be frozen. In contrast, were you to dive in, paddle around for a moment, and then get out, you’d experience all the powerful benefits of cooling off followed by warming up. The positive reinforcers for small appetitive actions are like that—they are too small to maintain behavior in comparison to the negative reinforcement that avoidance affords. The way to generate contact with larger magnitude reinforcers is to take just a few small steps followed by a dive. Diving in is scary in the moment, but with a skilled worker who is willing to simultaneously take their own dive into the breach, the probability of contacting the positive reinforcers for appetitive behavior is high.

The Matrix Sharpens Stimulus Control The ACT matrix is a tool that helps sharpen stimulus control. When learner behavior is under the control of direct contingencies of reinforcement, the learner is said to be responding effec­ tively to discriminations, abstractions, and generalizations. Skinner (1953) discusses each of these as aspects of stimulus control for which we use special tools to improve the learner’s behavior so that it contacts positive reinforcement. In simple terms, the matrix helps by clarify­ ing both the reinforcing consequences of behavior (whether appetitive or aversive) for the learner and the accessibility of the learner’s behavior to others. The matrix serves as a discrimi­ nation aid that sharpens the learner’s tacts regarding consequences and the level of privacy of their behavior. One repertoire brought under sharpened stimulus control with matrix work is that of selfknowledge. Skinner (1953) suggested that we develop self-knowledge when our verbal commu­ nity asks questions regarding things such as what we are doing, what we were doing then, what we will be doing then, where we are, where we were, and where we are going to be. We learn to tact ourselves in time and space in relation to other people, times, and places. As you learned in chapter 1, RFT refers to this as deictic framing, or speaking about I/here/now in contrast to you/there/then. RFT researchers note that it is also important that we learn to speak about ourselves as though we were there and then. This gives us the capacity to imagine, dream, and hypothesize alternative behaviors and outcomes based on what has and has not happened in the past. This special skill, apparently unique to the human species, provides us with evolution­ ary advantages for coordinating the activities of ourselves and others outside our immediate time and place. Yet, like an exquisitely refined bit of machinery, the “wiring” of this repertoire

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can get scrambled and require sophisticated labor to disentangle. The matrix makes short work of this by honing learners’ skills at zooming out to see themselves as though they were separate from the drama of their lives. Deictic framing, brought to bear during matrix exercises, helps individuals learn to make conditional discriminations regarding features, functions, and classes of their own verbal behav­ ior. Distinguishing between these aspects of overt behavior can be challenging enough. Doing so with covert behavior is twice as complicated, because the controlling variables are more difficult for the learner to identify. But the matrix simplifies this discrimination task and places the emphasis on active engagement in the discrimination task rather than on correct tacts of the controlling variables or form, feature, and class of the behavior. This is an important aspect of using the matrix for the right purpose: our goal is to facilitate socially significant, observable measurable behavior. To that end, teaching a learner to discriminate aspects of their behavior and its controlling variables involves reinforcing engagement over accuracy. I will say more about this later in the chapter. The receptive language skills involved in observing your own verbal behavior for its fea­ tures, functions, and class membership involves hierarchical framing. Typically developing chil­ dren learn this during intraverbal exchanges with their parents and teachers. Others require carefully engineered learning environments for the acquisition of these skills. Interestingly, when our behavior does not immediately contact positive reinforcers, whether the behavior is undergoing extinction, punishment, or just a long, slow wait before reinforcement becomes available, hierarchical framing becomes more labored. It seems that looking objectively at our­ selves and our behavior is more difficult when we are not contacting positive reinforcement. Of course, it should be noted that not all extinction contingencies are bad, so long as new behav­ iors are induced and reinforced. In fact, ACT works largely because it is a verbal extinction procedure. But when we are contacting negative reinforcement or punishment in particular, our repertoires become narrower, focused almost exclusively on immediate avoidance or escape. In these moments, we lose the aptitude for conditional discriminations involved in classifying our public and private behavior. The ACT matrix serves as a conditional discrimination aid for improving the receptive language skills of highly verbal learners who are not responding to otherwise skillful direct contingency management strategies. Hierarchical and deictic framing are thus among the first repertoires to be jump-started during matrix work.

Introducing the ACT Matrix to Clients In the chapters that follow, many examples of behavior analysts using the matrix will be pre­ sented. Many of these exemplars will assume that the client has already seen the matrix and can follow its conditional discriminations. The first time a behavior analyst introduces the tool, it will seem foreign to the client. A good strategy is to ask the client’s permission to show them a simple diagram, a grid with two lines that cross at the center of the page. From there, it is

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useful to present the four initial discrimination tasks that comprise the main quadrants of the matrix. Although these tasks can be presented in any order and I personally find it easiest to begin with whatever content the client presents, it is quite sensible to begin in the lower right corner (values) and work around the matrix from there in a clockwise fashion. Given that you have identified a socially important ABA target to focus on, there are four simple questions to ask, one for each quadrant of the grid.

1. What is most important to you about         (your work, your child, school, sports, etc.)? Often the place to begin in the matrix is by asking questions about values and writing the client’s responses in the lower right quadrant of the matrix. In applied behavior analysis, we are expressly focused on helping people achieve certain goals that are specified at the outset of treatment. Finding out what a person cares most about in this specific area is a vital way to begin building behavioral momentum to follow your suggestions for action. Psychotherapists may do a more sweeping inventory of values across multiple life domains (health, family, work, leisure, spirituality, etc.). But because behavior analysts are employed to produce more welldefined behavior changes from the outset, it is important to frame the question with respect to the particular domain in which our work is targeted. Questions can be framed in many different ways, depending on the nature of the profes­ sional relationship or the developmental level and verbal skill of the client. For example, when talking to an employee, a supervisor will usually want to use the matrix to clarify vocational values, so a question along the lines of “What matters most to you about working in this field?” would be useful. Working with the father of a child with autism might occasion a question such as, “How do you want to show up for your child? Imagine that twenty years from now, he has the skill to look back on how you were with him. What would you want him to say about how you aimed to be with him?” The matrix is useful with children of varying verbal skills and developmental levels. It is up to the practiced worker to carefully assess words for their capacity to evoke on-track intraverbal responding from the child. Questions such as “What do you like most about your teacher?” are a good starting point. With some children, it is best to begin with a matrix that has embedded drawings that the child can color when talking to you. Other children can write words inside the drawings. Still others may open up when given finger paints, clay, or found objects with which to glue together small sculptures while they talk. The matrix can be introduced as a giant floorboard on which a child manipulates distinctive media in each of the four quadrants to help them conceptualize their differences. In the lower right quadrant, the analyst’s aim is to help the child say, in their own words, what is important to them.

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2. What things that other people can’t observe get in the way? The lower left quadrant of the matrix is where private thoughts, emotions, memories, and bodily sensations are listed. A skilled analyst will model this using a personal disclosure that is not very emotional. For example, a behavior analyst might say, “I sometimes remember times when I didn’t perform well and I think to myself, ‘I’m about to mess up just like I did then.’ No one knows I’m thinking that way, but I go there, and it gets in the way of my being the kind of worker I want to be.” It is entirely possible that a teacher, aide, parent, or employee familiar with ABA will inquire why a behavior analyst is asking about their unobservable behavior. There are two issues here. First, as before, the questions that a behavior analyst asks about private events are linked directly to socially significant, observable behavioral goals, and this is important for the analyst to point out. Second, it is wise to have a well-rehearsed elevator pitch that answers this ques­ tion. Here is an example: That’s a fair question. BCBAs don’t normally target behavior beneath the skin for change. Fortunately, nothing is different here. I’m going to help you manipulate the variables that influence the performance you asked for my help with. It’s tricky, though, because you’re engaging in private behavior like thinking and remembering that is influencing your current performance. In some situations, your private behavior is not an issue and all it takes to improve your performance is changing a sign on the wall or making sure there are two tickets to a ballgame that your accountability partner has waiting for you when you complete a difficult task. But in this situation, you and I have already tried these kinds of strategies and you’re still getting stuck. So, for this matter, I’m asking that we approach your private world and see if we can change things up so that it doesn’t stop you the way it has been doing. The exact words you use to address the issue will depend on the amount of formal training that the person asking you has had in behavior analysis. A good rule of thumb is that unless your audience often uses behavior analytic jargon in casual talk, it is best to find precise ways of speaking without the technical terms. Jargon is useful when speaking to others with the requi­ site background because it increases the precision with which you speak and reduces the overall number of words that need to be said. But jargon is difficult to follow, even for those with the background, and it may turn them off. Instead, develop and rehearse precise ways of communi­ cating the behavior analysis behind ACT so that when you are asked why the matrix has them answering questions about private events, a good answer rolls off your tongue. When asking questions about private events that get in the way, it is also important to underscore aversive physical sensations such as perspiration, elevated heart rate, and trembling. These are particularly important because they may in some cases be observable to others. Even if they are not, the individual with these sensations is likely very familiar with their physical characteristics and can label them with more clarity than they can their own emotions.

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In fact, for most people, labeling emotions is remarkably difficult. Right now, try defining the difference between embarrassment and shame. If you are like most people, these two words are familiar but the border between them is indistinct. (In case you’re interested, feeling embar­ rassed involves what others think about you and feeling ashamed is usually defined in terms of how you feel about yourself.) In a later section of this chapter, the importance of stressing engagement over accuracy when asking clients to use the matrix will be discussed in detail.

3. When things are difficult, what do you do that others can observe that doesn’t work out well? In the top left quadrant of the matrix, you are asking clients to list overt behaviors that you will target for change by manipulating direct- and indirect-acting contingencies. Some of the behaviors they indicate will be matters you’ve already discussed together. Others could be new behaviors you did not know about. Still others are old behaviors that were discussed as being of low priority that are changing in function. Finally, some could be precursor behaviors that, listed in this fashion, can help clients observe the conditions under which they engage in more seriously challenging behavior. It is worth noting that this is a list of response topographies. Behaviors slated for reduction can be gainfully listed in terms of their topographical properties, so long as an assessment of their function follows. The matrix is organized as a visual aid facilitating this assessment in that, by virtue of the questions that preceded this list and the place it occupies on the grid, these behaviors are hypothesized to be negatively reinforced. In combination with the list in the lower left quadrant, these are private/public behavioral clusters that are hypothesized to be under the overarching control of experiential avoidance, but other indirect functions may be uncovered during the matrix sorting procedure.

4. What would you be doing that would work better and would be in step with your values? Replacement behaviors are functionally equivalent alternative responses. That is, replace­ ment behaviors contact the same reinforcement that undesirable behavior does, but in socially acceptable ways. It is important that behavior analysts teach service recipients and employees ways to powerfully operate on their environments to avoid or escape toxic situations. However, the right top quadrant of the matrix points to appetitive behavior that contacts a different, more powerful class of reinforcement for approaching difficulties. The behaviors listed here are what we might term successful operants. They are the actions a person is taking when connected to their deepest yearnings for purpose and meaning. One reason it is sensible to start in the lower right quadrant and work clockwise to end up in the top right quadrant is that the process of sorting behavior on the left half of the matrix jump-starts oppositional framing. This increases the desirability of alternative behavior or

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makes otherwise aversive behavioral functions appetitive. Notice that having underscored the ease with which the difficulties of reading this book could be mitigated by closing it, you elected to focus on the long-term benefits of staying with it. Oppositional framing of the appetitive aspects of otherwise aversive events happens rather naturally when working across the matrix in this fashion. The process can be quite lighthearted, free of the weighty and tearful emotional work that is often a part of ACT used as a psychotherapy tool. Clients are often quick to indi­ cate observable, measurable behavior that they are not currently engaging in but that would be in sync with their stated values. Because the matrix is merely a writing exercise that only hints at action to be taken, the discrimination tasks may lead to curiosity about what these actions might be like. You may, for example, observe evidence of this curiosity opening up in the client’s demeanor, such as a softening of eye contact or an opening of the shoulders. It is often powerful to point this out and watch for continued softening and opening as these behaviors are reinforced. With children, there is a wide range of ways to ask valuing questions to fit their develop­ mental level. “What are you doing when you and your brother are having fun together—are you frowning or smiling? Are you quiet or talking with each other? Are you away from or near each other?” These are leading questions, but they help a younger learner with less developed verbal skills master a simple discrimination task. Later, conditional discrimination tasks can be layered in by asking, “What is your brother doing that lets you know it’s okay to hug him? What is he doing that lets you know he’ll feel better if you leave him alone for a while?” These questions improve the discrimination of differential actions that are equally consistent with a value of being a kind sibling in a variety of circumstances. Later, the analyst would practice the discrimi­ nation in games and activities and ask the learner to try out a new behavior at the first oppor­ tunity after session. As with other ABA targets, it is important to foster generalization of new skills to novel situations in the natural environment.

Some Considerations in Using the ACT Matrix The ACT matrix may be used as an assessment tool, intervention aid, or both. Regardless of how you use it, there are a few considerations to bear in mind about engaging clients in dis­ crimination tasks, identifying desirable outcomes, validating client verbal statements about their experiences, and maintaining a strong therapeutic alliance. The following sections offer guidance on these topics.

Emphasizing Engagement Over Accuracy of Discrimination Very few examples can be found in the empirical literature of one-trial learning. Conditioned taste aversion is the quintessential illustration on single-trial learning. When a neutral stimulus (oatmeal) is presented with an unconditioned stimulus (sour milk), nausea and vomiting follow. Immediately after this event, any subsequent presentation of oatmeal by itself is followed by the

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same nauseous sensation, a newly acquired respondent vomiting, and operant avoidance of oatmeal. Most learning is nothing like this. In most cases, respondent and operant learning is gradual. This is the case when learning to discriminate behavior into the four quadrants of the ACT matrix. It would be easy to correct every mistake a learner makes to come up with a matrix with all the bells and whistles. It sure would make a perfect wall hanging. Unfortunately, it would be art no one cares to look at and, more importantly, it would be nothing a learner would be moved to act on because the corrections would serve as punishment for incorrect answers. We do not tend to keep trying after behavior has been repeatedly punished. We usually stop what we were doing, and if what we were doing was trying something new, trying out novel behavior would be exactly what we’d stop doing. Instead of correcting, a skillful facilitator will jot down things exactly as the learner sug­ gests and later ask, “I’m looking at this and wondering if it might be good to move it up here next to this other thing. What do you think?” The emphasis is on engaging the learner with the discrimination task rather than perfect accuracy on every discrimination. This helps because discrimination is likely to improve over time during the intervention phase, as specific behaviors are targeted and practiced. In this way, the initial loops around the matrix are warm-up runs, not races. Importantly, the analyst is setting the stage for a learner to try using the matrix independently. It is important the learner’s first efforts are positively reinforced so that they will continue to sort in this fashion when the behavior analyst is not present. Independent discrimination and associated action are the goals. It is desirable that when looking back at an effort to try something new, the learner tacts private behavior that was ­co-occurring. Learning happens when the individual notices that they felt anxious, sad, or fearful as they tried out an appetitive response that subsequently was reinforced.

The Outcome Is Process and Context Practices, Not Solutions or Answers A very similar pitfall is observed when practitioners use the matrix to generate solutions or answers for a client. This is problematic for a variety of reasons that were discussed in earlier chapters. It is worth reviewing these issues here, because they are common matrix pitfalls that are easy to fall into. First, problem-solving is a repertoire that serves ABA clients when the problems are entirely practical but not when the problem involves trying to control or eliminate private behavior. For example, learning how to tie a shoe when fingers lack the fine motor development is a problem easily solved by making a larger discrimination aid. A giant wooden shoe with fat laces placed on a table provides all the environmental adaptations needed to teach the skill, after which practice can be scheduled with gradually smaller versions of the shoe. But what if the problem is that after repeated failures, the warmest and most skillful coaching from Mom results in the

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child saying, “I’m a loser; I always fail”? In this case, teaching ways to bring emotions under control would be like placing band-aids on a cracked windshield. It’s the wrong tool for the job. Second, the aim is to generate discrimination, not solutions. ACT aims to facilitate obser­ vation of covert behavior rather than efforts to change it. Rather than solving emotional prob­ lems, the matrix can be used to promote noticing what happens when repeatedly taking action that is hard. The outcome may be that emotions change, but even if they do not, positive reinforcers are contacted. If these reinforcers are powerful enough, the learner can be coached to make healthier choices in a variety of novel situations to follow. Third, the most workable outcome of using the matrix is the identification of process and context practices to be rehearsed during and outside of session. Process interventions are exer­ cises in which clients rehearse ACT moves during their downtime. ACT moves are best learned and initially practiced when there are limited stressors present. Later, when stressors are present and these skills need to be recruited, they will be at strength. It is a bit like practicing a back­ hand stroke in tennis. Most players find forehand strokes easy to pick up. Backhand is more difficult because it involves muscles that are usually not as well developed. When a ball is hit toward one’s backhand, it is common for the beginner to run out to get on the other side of the ball and hit it with a forehand. But if successful, this gives the player’s opponent an advantage— a lob to the other end of the court will be too far for the player to run to. Learning to hit back­ hand shots places the player at the center of the court—in position to field anything on the next volley. It takes practice, often in mass trials and with multiple situations. Process exercises are the ACT practice sessions that, like backhand drills, build fluency at critical performance repertoires. Context interventions that are identified during matrix work are also distinct from solu­ tions and answers. They are similar to the backhand practice discussed above in that these rehearsals are practice drills of the socially significant, observable, measurable behaviors that are targeted for acceleration. Practicing a difficult behavior during downtime—manipulating the conditions to make it easier at first, and progressively more challenging later—is the stuff of ABA. Combined with process interventions and strategies for reinforcing data collection, context intervention is the substance of ACT committed action.

Is This an Away Move or a Toward Move? Imagine this: you’ve stepped outside into the cold midwinter air during a snowstorm and quickly put on a wool hat. What is the operant reinforcement contingency at play: positive reinforcement (obtaining warmth) or negative reinforcement (escaping cold)? The surprising answer is that there is no definitive answer. If the motivating operation is the aversive stimula­ tion of the cold, it is a negative reinforcement contingency. But if the motivating operation is deprivation of warmth, we would say that this is a positive reinforcement contingency. Whether the MO is aversive stimulation or deprivation is really a matter of words. For philosophers of science, this is a conceptual issue that has led to many calls for eliminating the terms positive and negative from the technical lexicon of our field (e.g., Michael, 1975; Barron & Galizio,

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2005). In practice, no such drastic change is necessary. You teach the learner to put their hat on and reinforce this action. To some degree, the same occurs when sorting behavior along the matrix. A high school boy with autism who jogs five hours a day and behaves aggressively if he is unable for any reason to complete his full running circuit says that jogging helps him find meaning in his life. Aggressive behavior is clearly on the left side of the matrix for this boy, but how about jogging? I worked with a boy that I’ll call Carl whose behaviors were similar to this, and he sorted jogging into the top right quadrant of the matrix. I might have viewed Carl’s jogging to be a behavior that was under aversive control because it was something he thought that he had to do in a specific way, in a specific location, and for a specific duration of time. I would therefore have sorted jogging onto the top left quadrant of the matrix. Had I attempted to impress this upon Carl, I would have likely been on the receiving end of his aggressive behavior. Instead, I asked him to sort his behavior each day for a month. For weeks, Carl placed jogging in the top right quadrant, and nothing much seemed to change. At some point after a number of sessions, Carl came in and said that he noticed how terrified he was when he was running that maybe he’d get stronger and faster and finish too quickly, which would be against his rules. That was when he asked if it would be okay to also put jogging in the top left quadrant of the matrix. For many weeks after this, jogging appeared periodically in both quadrants and alternately in the top left but not in the top right quadrant. I continued to follow Carl’s lead in assessing this behavior for the function it served. After some time, Carl became willing to try running for different lengths of time on different days. Later, he made a bold move and tried willingly jogging until a randomly set buzzer in an app on his phone vibrated, after which he turned around and walked home. At that point, Carl noticed that he was more curious about the daily pattern of the timer than he was anxious about following his rigid run time rules. The function of jogging transformed more permanently and from that point forward, Carl sorted it consis­ tently in the top right quadrant of the matrix. My guess is that this was as much a prompt to himself to hold his rules about running lightly as it was an observation of what it had been over the past day. Self-feedback often works that way, serving as both conditioned reinforcer and discriminative stimulus.

Validating My tack with Carl was emblematic of a central facet in all ACT work that has special rel­ evance for behavior analysts using the matrix. The therapeutic alliance in ACT requires a stance of mutual inquiry. There is no expert and no clueless beginner. We are all beginners with a skill set that is already working for us. This is a difficult pill for practitioners trained in other psychological models, and it is espe­ cially difficult for BCBAs to swallow. BCBAs are professional problem-solvers, experts trained to always have answers. Learning to be a lifelong beginner is a challenging shift in orientation. On top of that, there is the fact that the matrix is likely going to be easy for behavior analysts

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to figure out and less so for clients. Therefore, there is a built-in pull to being right and making learners wrong. An additional difficulty is that all behavior is adaptive and therefore, no matter what a client is doing, it is working for them in some way. It might not be working the way they think they intend it and it might not be working in the long term as much as it is in the short term. But if it is happening repeatedly, it is producing reinforcers that are maintaining it. Skillful ACT practice, particularly when using the matrix, begins from a place of curiosity and nonjudgmental inquiry. The ACT practitioner uses validation to open the client to this kind of engagement. Validating involves acknowledging a client’s experience and perspective. It does not mean agreeing with or even supporting a client’s actions. It involves taking the learn­ er’s perspective and letting them know that what they see and do is what anyone with their background would perceive and do. One approach to validation is to make the following kind of statement forthright and directly after using the matrix for assessment and before transitioning to intervention: I am not surprised that this is the way it all occurs for you. You had the experiences you had growing up and most recently you went through what you went through. Anyone would see other people and these kinds of situations the way you do. Not only that, but it is also understandable that you have developed the behavioral patterns that I’ve observed and that we are discussing. Again, what you do is what most people would do in your situation. Of course, you didn’t come to me for help because all of this is working just the way you’d like it to. So, there are things for us to do. There are a few behaviors that you would like help with and that I will work with you to change. But as a starting point, it’s useful for you to know that what you’ve learned to do has worked for you in the past and probably still gets you some of the things that you need some of the time. You are not broken. It’s important to me that you know that. You are a beginner about to learn new skills. Fortunately, I have some experience being a beginner. I am a beginner myself at the very things I am going to be teaching you. When I say I’m a beginner, that doesn’t mean that I don’t know what I’m doing. It means that I am skilled at approaching everything I do every day with the inquisitiveness of a new learner. I neither know for a fact what I am going to do nor that what I will do is going to work. You could say that’s why my work and my life are always interesting to me. I am committed to discovering what works. I’m committed to helping you discover what works for you. In that, I am your partner, a fellow beginner, someone standing—as are you—at the intersection of two paths. We are embarking on a journey as travel mates. And with that, the stage is set for a therapeutic alliance to grow in which the client experi­ ences a validating environment. The behavior analyst thus serves as a nonpunishing audience in position to teach the client to discriminate contingencies and try new behaviors. Further, the analyst is in a position to reinforce these efforts, to teach the client to observe the outcomes of

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trying novel behaviors and to generate new, more flexible rules. Finally, the analyst can now teach the client to watch for the outcome of behavior under the control of the new rules, and to generalize their use to novel environments and people.

At the Center of It All… Validation and building the therapeutic relationship create the conditions in which the client can learn to notice what they do without judgment. This is perhaps the most challenging enterprise of all because if the client has developed an evaluative framing repertoire, it is likely being overused when they are receiving help from a behavior analyst. After all, the prevailing cultural disposition is that to feel anything other than good is bad. Therefore, if you need help, you must be bad. Overextended evaluative framing in this context is a bit like being a carpenter with a hammer to whom everything looks like a nail. Learning to search the full contents of the toolbox is part of the apprenticeship in the carpentry guild. So it is with the ACT matrix. In carpentry, the simplest way to learn to look for the right tool is to lay them all out in a circle around you on the floor and inspect them one by one. The matrix is learned the same way—the flexibility perspective is adopted when the learner begins to see themself at the center of the matrix, looking at all four quadrants from there (see figure 5.1). The result is that the learner begins over time to use other framing repertoires equally (opposition, coordination, hierarchy, deixis, to name a few). This paves the way for treatment.

Figure 5.1

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Connecting Assessment to Treatment Thus far, we have only hinted at ways the matrix can be used as an intervention tool. For the most part, the discussion so far has focused more explicitly on assessment using the matrix. Transitioning into treatment involves occasioning action by making the right half of the grid discriminative for behavior that produces vital, life-enhancing reinforcement. To this end, a question that can be useful to ask is this: What if you were standing at a fork in the road and you could live out the rest of your days at this job (or with your child, etc.) walking in either of two directions. To the left is a path that is much like the one you’ve been on up until now. Every step you take will be about staying clear of things that stress you out and most of the time you’ll avoid being deeply uncomfortable. The other path is to the right. It’s a steeper, uphill climb but taking that road means you’ll be moving toward the things you yearn for, the people you cherish, and being the best person you can be. Remember, the choice you make now puts you on a path that could be forever. You get to choose. Which road are you going to travel? If the assessment strategy thus far has been successful, a transformation of stimulus func­ tion of aversive situations has probably already begun. Between that and the fact that, in most cases, a behavior analyst will have begun this process only after having been asked to assist with changing these behaviors, the likelihood is that the client will choose the path forking off to the right, toward valued action. Given that, the next step is to ask: Are you willing to try out some wobbly first steps up this path together with me? I am pretty certain it will be challenging. It’ll be tough for me too. All the stuff you wrote about down here in the lower left will be surfacing. Are you willing to learn how to do these things in the upper right quadrant when these things in the lower left are getting in the way? (Adapted from Polk, Schoendorff, Webster, & Olaz, 2016.) If your client’s answer is yes, you are ready to begin developing process and context inter­ ventions using metaphor and action. In the next chapter, you will learn how to listen for and use metaphors in client speech.

CHAPTER 6

Metaphors

Research on Using Metaphor to Influence Behavior People read books, watch theater performances, and go to movies that elicit strong emotions. Aristotle suggested that fear and pity elicited during performances of the great tragedies served as cathartic warnings to viewers who might veer away from immoral behavior after seeing the fate bestowed upon otherwise godlike characters (Aristotle, ca. 350 BCE/1925). We commonly refer to Oedipal hubris and Iago’s envy as metaphors for common failings that can be avoided with humble behavior. Therapists have long used metaphors in session and such is the case in ACT work. But what is the evidence that using metaphors will generate effective action in ABA clients, staff, and others? First, it is useful to note that Skinner (1953) discussed the way reinforcement works to change behavior using the metaphor of a “strengthening” operation. Reinforcement strength­ ens behavior as exercise strengthens a muscle. His early writings used this metaphor as a guide to interpreting results from the experimental analysis of behavior and to the development of an applied technology of behavior change. Later, Skinner abandoned this metaphor in favor of a more robust one that linked psychology and biology. Beginning in 1968, Skinner proposed that behavior is “selected” by its consequences. The selection metaphor influences the way behavior analysis is taught and practiced today and has been instrumental in spawning many additional programs of research, such as those related to metacontingency (Glenn, 1986), metabehavior (Mawhinney, 1995), and macrocontingency (Ulman, 1998). Another metaphor that has influenced scientific inquiry in behavior analysis is that of behavioral momentum (Nevin & Grace, 2000). Borrowed from physics in which the quantity of motion is a function of velocity and mass, the metaphor of momentum suggests that ongoing response rate and persistence are determined separately by response-reinforcer and stimulusreinforcer contingencies. In practical terms, you might consider a bowling ball at rest. If you flung a tennis ball at an eight-pound bowling ball, you would not move the heavier ball an inch. But once the bowling ball is in motion down a bowling lane, throwing a tennis ball at it would easily alter its trajectory and send it into the gutter. The behavioral account of momentum started as an effort to quantify resistance to extinction as a means of further understanding the temporary effects of reinforcement, but it has led to a technology of behavior change known as

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the high-probability command sequence, an antecedent strategy for increasing compliant behavior (Beliofre, Basile, & Lee, 2008; Davis, Brady, Williams, & Hamilton, 1992; Mace et al., 1988; Nevin, Mandell, & Atak, 1983). Thus far I have discussed the way metaphors are influencing the course of scientific inves­ tigation in behavior analysis, but you may be wondering at this point whether metaphors can be used in session to change client behavior. In a college educational context, Witts, Arief, and Hutter (2016) provided evidence that students of behavior analysis can be taught to identify complex verbal operants such as metonymical tact extensions when given the text of a popular song, Lady Gaga’s “Applause.” The students used operant verbal analysis to generate an inter­ pretation of the song’s ambiguous and challenging thematic concerns. Simultaneously, the experimenters used metaphor to teach Skinner’s verbal analysis! Using an ACT approach with children who threw tantrums when game rules were changed, Szabo (2019) filled a large bowl with ice cubes and asked participants to hold a hand under the ice for as long as they could. The children were also instructed not to feel cold under any cir­ cumstances. Participants were timed for how long they could hold their hand under the water, and there was no immediate debrief of the activity. After a different activity, participants were again asked to try to hold their hand at the bottom of the ice bowl for as long as they could, but this time they were instructed to be curious and marvel at the sensation of being cold. Again, they were timed, and the event was debriefed. In this exercise, ice cubes served as a metaphor for rule changes—they share the common properties of being uncomfortable, but manageable when you quit trying to get rid of the discomfort and instead engage with it as a game. (The Bowl of Ice Exercise is described in more detail at the website for this book, http://www.newhar­ binger.com/45816.) In the same study, Szabo (2019) brought family members together and asked them to hold on to a ten-foot rope tied together at the ends. They were asked to imagine that this was the world and that the rope was the Earth’s atmosphere, shielding everyone they cared about from the cold vastness of outer space. They were then asked to say what they might commit to doing to protect each other and anyone else they cared about. The exercise metaphorized a rope as being similar to the Earth and holding on to the rope as akin to protecting the people you care for. These metaphors helped generate willingness to experience discomfort and valued action in service of others. (In chapter 7, I will come back to these metaphors to discuss the way physi­ calizing them helped increase their salience in the therapeutic context.) In an indoor rock-climbing performance context where young adults with autism withdrew from practice prior to competitions that were scary due to the social pressure these events gen­ erated, Szabo, Willis, and Palinski (2019) asked participants to imagine that their thoughts of letting their team down were like handholds that they were jumping to. They were instructed to imagine that as they were getting closer to the hold, they could feel their body slowing down. Next they were told to slow themselves down as they moved closer to their thoughts and tried to catch them in flight. The metaphor of thoughts that can be caught was physicalized in a climbing context in order to help participants develop curiosity about their reactions to aversive aspects of competition.

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Taken together, these studies show that using metaphors can be effective aids to improving discrimination of aversive verbal contingencies that limit behavior from appetitive verbal arrangements that leave behavior less constrained. More broadly, in this section I have sug­ gested that metaphors play a central role in conceptual, experimental, and practical aspects of scientific enterprise. My intention in this has been to set the stage for a more detailed taxonomy of the elements of effective metaphor elaboration to be used in applied practice. It is to this task that I now turn.

Common Metaphors in Speech In chapter 1, I provided a brief technical account of the way metaphor is learned and operates in Skinnerian and RFT terms. In chapter 3, I built on that framework and suggested that to be effective, metaphors should make sense, elicit strong emotions, build broadly on a client’s learn­ ing history, and maintain connection with currently pressing circumstances. I made the case that ongoing functional assessment of the role that verbal behavior plays in maintaining inef­ fective performance is the wind that powers the sails of a metaphor in generating effective action. Then in chapter 5, I submitted that when introducing the ACT matrix, a simple meta­ phor of “standing at a crossroads” works to call attention to the choice of either continuing to behave in ways that work for staying clear of difficulties or trying difficult, new behavior that moves a person toward the things most precious to them in life. Introducing the metaphor of “standing at a crossroads” is often all it takes to set the stage for a client to come up with their own metaphors when answering questions throughout the four matrix quadrants. You can imagine a client following it by saying, “I guess I’ve been at this turning point a number of times in my life, and I’ve always turned left.” In a moment, I will address the many ways that you can further occasion and facilitate this kind of metaphorizing as you transition from assessment to treatment using the ACT matrix. But before I discuss the devices that work to bring subtle, deeply ineffective patterns of behavior to life through metaphor, it is important to notice the intrinsic metaphor-like quality of nearly every verbal utterance. Language lends itself to the figurative, and even the most con­ crete, literal, and verbally limited of clients with only the most basal verbal skills (mand, tact, echoic, and intraverbal repertoires intact but nothing beyond that) make use of nonliteral phrasings, whether they know it or not. By way of illustration, take the last sentence. Language does not lend itself out in any literal way. It does so only in a metaphorical sense, when it has been personified in coordination with a functional context that favors generosity. As well, clients may be concrete, but only in a metaphorical way. They are certainly not made of stone, gravel, and cement and they are not hardened over time when mixed with water. For that matter, clients can be literal only in the most nonliteral way. That is, clients are usually said to be literal only in a functional context where being something other than literal would be more desirable. The word is used in a frame of distinction from being capable of abstract thinking. When speaking of one as being literal, it is more as if to say that their verbal behavior is limited

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as in the Latin litterālis “to the letter” of that which they say and hear. But if you truly believe that about a client, try saying to them, “You appear to be down today” or “You seem more up today,” and watch to see if they follow. This is a common metaphor in which down is bad and up is good. In fact, it is so common and well understood that for most people it will have lost its capacity to elicit emotion and evoke playful verbal banter. As such, it is a good control by which to test the assertion that a client is too literal to respond to metaphor.

Catching Metaphors in Flight The ubiquity of metaphor in everyday discourse is a good thing. The ACT matrix asks you to write out what clients say, so when you are writing down their responses on a matrix grid, you can underline metaphors and either stop the action to emphasize one of them in the moment, or complete the matrix and then come back later to focus on the most evocative of the meta­ phors that the client uttered. To make use of the metaphors in a client’s speech, you should be listening for tells regarding the indirect function of their words (see chapter 3). Given their ubiquity, spoken metaphors in and of themselves are not necessarily important. But in the context of an ACT repertoire that you have slated for intervention, these same metaphors can be brought to life for a specific purpose. Consider the following example: Supervisor:

Those are some very important tenets by which to live.

RBT:

Helping my clients succeed is mission critical for me.

Supervisor:

Now what are some things that I wouldn’t be able to notice but that get between you and completing your job responsibilities that help clients succeed?

RBT:

Well, I tell you. My boots have big, nasty holes in them. You can’t see them, but they’re there. And underneath my feet, there’s a boulder field of sharp, penetrating rocks that I have to walk across. There’s a lot about my job that hurts and that I just have to walk through. Namely, parents resisting what we do.

In this brief exchange, the RBT has used two crisp metaphors. First, the RBT used the phrase “mission critical” to describe a value related to ABA work. Second was the image of “boots” unraveling while crossing a field of sharp stones. The supervisor could focus on valuing the mission, accepting pain as rocks brush up against the soles of the RBT’s feet, defusion from the “have-to” rule, or any combination of these functions. Which of these should the supervisor focus on? The answer is that the client’s behavior should select the intervention target. As you learned in chapter 3, it is always useful to explore individual utterances to find out whether what sounds like one thing is really something else. In the current example, the RBT’s image of

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“sharp, penetrating rocks” could be related to a pattern of avoidance of emotions related to work in certain contexts. But the same utterance could have just been the RBT’s verbal setup for letting the supervisor know he is hooked by a rule he says to himself that he “has to” keep walking. To build a functional architecture of this image, the supervisor should continue by asking questions that uncover the existing metaphor’s scaffolding. Supervisor:

I love that image. I guess my boots have holes in them too. Would you say that the pain of marching on when parents do not appreciate the work you are doing is what is getting in the way? Or is it more that you feel you have no choices here—that you are forced to walk over these rocks, day in and day out, on your job?

RBT:

That’s a great question. I think it’s not the pain so much as the fact that I have to get better at working with parents. I didn’t think it would be this way when I started—I thought parents would be thrilled by what we’re offering. I didn’t know that to be effective with a kid, I’m going to have to work with parents who are resistant.

Supervisor:

Let me see if I get this right. You’ve been walking this walk for some time now, and your boots have worn through. It hurts sometimes when you’re marching along, doing your job. That’s not so bad, though. What really gets to you is the sense that there’s no other path but this sharp, rocky boulder field that you’re on right now, if you want to be effective with the kids.

RBT:

That’s exactly it—yes.

The supervisor in this exchange has uncovered that fusion to a tightly held notion of how ABA with parents is done is getting in the way. Very likely, following the rule just this way has been effective for the RBT in the past for avoiding criticism from other supervisors or even from this one. The supervisor can now address the fusion, again making use of the RBT’s own vibrant metaphor. Supervisor:

Well, let’s look more closely then at this rule. You’re saying that you sense you have to get better at working with parents.

RBT:

You’ve pretty much told me that in the past, in our supervisions.

Supervisor:

It is certainly the case that walking this trail gets you where you want to go.

RBT:

So that’s what I have to do.

Supervisor:

I don’t know. You’ve gone hiking before, right? When you’ve planned a hike in the past, did you notice that some mountains have different paths that go to the summit? Maybe one goes up a steep, rocky slope. But there might be another that winds around through the soft underbrush of the forest before reaching the vistas at the top.

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RBT:

You’re saying I don’t have to learn to teach parents?

Supervisor:

Well, if you were to approach me and say, “I prefer to work with young adults and elders. That way I can focus on helping my clients succeed on their own terms, which is what is really important to me. I’m not so interested in meeting parent expectations for their kids. I want to see people get what they want out of life.” If you came to me and said that, I’d help you start hiking a different trail.

In this scenario, the supervisor caught the RBT’s metaphors in flight, used these figurative expressions to refine her functional assessment of the verbal barriers to the RBT’s performance, and further used them to illustrate appetitive alternatives that are likely to contact positive reinforcement in their work setting. Numerous examples like this will follow in the chapters to come. The important thing to note here is that clients often use metaphors. Some are more common and can go unnoticed. Others are more vibrant and therefore easy to spot. In either event, these constructions can be fleshed out to generate a clear sense of the verbal traps that clients are caught in and ways to release the mechanisms so that clients can easily move toward alternative, more effective actions.

Enhancing Metaphors for Therapeutic Purposes In the example above, the supervisor contrasted two trails that led to a mountain’s summit over distinctly different kinds of terrain, thereby offering two very different experiences for a hiker with worn-out boots. This use of contrast is a literary device that serves to enhance a metaphor that the client used in passing. Given the ubiquity of figurative and metaphorical utterances in common intraverbal exchanges, it seems worthwhile to discuss other such ways that metaphors can be enhanced to bring inflexible repertoires into focus and generate pathways to new behav­ ior. In the next section, I discuss seventeen literary devices that can be employed to power ACT interventions. Loosely, it serves to call these devices aspects of metaphor. However, more pre­ cisely speaking, metaphor is one literary device and the others I am going to detail are other stratagems that are distinct from metaphor. Because we are not working within an English composition context, that is a liberty I can take in order to maintain consistency with the ACT literature on using evocative metaphor for therapeutic purposes.

Allegory An allegory is a story, poem, or image with ambiguous characteristics that can be inter­ preted as hidden meaning. Clients are encouraged when hearing an allegory to interpret its theme. Lady Gaga’s “Applause” is such an allegory in that it shows how artists use their media to control the contingencies of reinforcement and thereby upend the need to wait for audience approval. You might say that Witts, Arief, and Hutter (2016) used these allegorical lyrics as an allegory for the power of Skinner’s analysis of verbal behavior to effectively select interpretive

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comments from undergraduate students. The movie Inside Out (Docter & Del Carmen, 2015) is another allegory for the importance of allowing children their emotions and being wary of the cultural dictum to always be happy.

Allusion An allusion is a brief reference to some person, historical event, work of art, or religious or mythological situation or character. Parent:

Feels like every time we get somewhere, something happens, the whole thing crashes, and we have to start all over again.

BCBA:

Very frustrating, I know. It’s so common, too. Some have even called this the human condition. The Greeks made up a myth to describe the problem because everyone faces it in one way or another. It’s called the story of Sisyphus. Sisyphus thinks he’s got life figured out, and then Zeus slaps him hard. Makes him roll a boulder up to the top of a hill in Hades, and every time he gets it there, the boulder rolls down the other side and he’s got to roll it back up all over again. You and me. We’re Sisyphus, aren’t we?

The analyst might ask the parent to say a bit more about this and ask her to write about it. In the future, when the theme of starting all over again shows up, the BCBA needs only say one word, “Sisyphus,” to suggest that we’re all in this together.

Ambiguity Poets use words or phrases that can mean more than one thing. An analyst helping an adolescent decide whether to continue with school or drop out might favor the use of ambiguity over more heavy-handed suggestions. Walt:

I kind of don’t want to go back.

BCBA:

Go back; go forward. Which is better?

Walt:

I’m asking you!

BCBA:

Perhaps you are. And I am asking you…

The device here involves reexamining the hackneyed “up is good / down is bad” metaphor discussed earlier. Western culture generally instructs us that forward is good and back is bad. Walt is hinting that returning to school would be like going backward. The therapist here is not telling Walt what to do, but instead asking Walt to consider the consequences of acting in each of two divergent ways. This is one of the most important aspects of working with metaphor in

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ACT. Literary devices like ambiguity foster the client’s reflection upon the consequences of their varied behavioral patterns. The client may subsequently engage in either of the two behav­ iors and then track whether the outcome comports with their prediction. Later, they may con­ tinue with a behavioral change that leads to the more optimal results.

Analogy An analogy is an overt comparison of relations in which one relation is familiar and the other is not. Walt:

I still think school is going backward for me.

BCBA:

There’s something interesting for me about this conversation. You’re saying that to me, but you don’t sound certain. Let me ask you to entertain a thought. Of course, this is just a thought, and I’m no more certain of this than you are. What if this is a game and, in this game, back is the new forward.

Here, the analogy is partially unspoken, but it goes like this: in games you move forward, but in the game of life sometimes moving back is going forward. Again, the BCBA refrains from strong suggestions and lets the client engage in AARR to defuse from the rule that he must move forward. In this, he may develop an appreciation of the consequences of different possible actions.

Apostrophe Speaking to a real or imagined listener or to an inanimate object is apostrophe. In the movie Cast Away (Zemekis, 2000), the protagonist addresses a volleyball as though it were a living friend he names Wilson. This technique can be used vocally to promote a light, defusing characteristic: Walt:

I still think school is going backward for me.

BCBA:

Going backward would certainly cause problems if all your thoughts were about moving forward. You’d kind of have to direct traffic so that no one would get hurt when your vehicle is moving in reverse.

Walt:

I have no idea what that would even look like.

BCBA:

Neither do I. You’d have to let all those thoughts know you’re coming, huh?

Walt:

Like a traffic cop.

BCBA:

Could you act that out? I mean, just say out loud what you’d say if you were a traffic cop letting everyone know someone’s going to back their car up.

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Walt:

“Okay, people, pull over, please. Let the man through.”

The same technique could be employed as a writing exercise in which the client is asked to write what they would say. BCBA:

If you do go back, you’re going to have to let everyone know, including the stairwells, the doors, the classrooms, and the chair you used to sit in during homeroom. How about you write a note to that chair letting it know you’re thinking about coming back sometime soon?

Cliché Clichés get a bad rap in poetry circles. Fortunately, you are not going up for publication of your work with clients in The Paris Review. If a parent you are supporting tells you that they’ve been “busy as a bee” and unable to conduct ABA sessions with their child, you might breathe new life (another cliché) into this older phrase by asking them to stop awhile at one flower, take in the fragrance, maybe even sit for few minutes on a petal to enjoy the moment. A present moment intervention such as this can bring behavior under new stimulus control just long enough for the client to try a new behavior. In this example, if the parent slows down, contacts reinforcement for being in the now, and tries doing ABA with their child in front of you, you can immediately reinforce this response, give the parent an assignment to try the same present moment activity during the week when “busy as a bee” shows up, and ask them to text you to let you know they conducted a session even though they were busy as a bee. Assuming you immediately text back, their behavior will have contacted your positive social regard, and will likely occur again in the future.

Contrast The BCBA working with an RBT who said her boots had worn through their soles when conducting parent training used contrast to differentiate two trails that would each lead to success at her job. Metaphor used to contrast differences in the processes and outcomes of behavior is usually nonthreatening to clients. After a client can tact these differences, it is fair to role-play, give feedback, ask for a commitment to act between sessions, and explore the ways that the client can provide you with evidence of having followed through.

Euphemism Please be aware that in this brief section I will address some very painful topics. Euphemism is understatement used to lessen the unwanted effects of words dealing with painful occur­ rences. If you are working with people in human services, there are hard issues that bring up

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deep pain that you will eventually encounter at one point or another. Not all of your job will center around teaching verbal skills to cute little ones. You may work with clients who have experienced death recently, have relatives living through the final devastating stages of cancer, or are working out the decision of whether or not to abort an unborn fetus. I have used unfil­ tered words in this description. In addressing these matters with a client, you may want to use euphemisms. The question is, to what end? What function will the use of euphemisms serve? If you are catering to experiential avoidance now, how will the client you work with handle thoughts and memories about this topic later? If you do not model straight talk about challenging affairs, how will your client learn to approach them for the purpose of healing and growing? Unfortunately, if you are a BCBA, you have most likely received virtually no formal train­ ing in graduate school on these matters. Some aspirant BCBAs train in pediatric feeding or elder care settings and learn about ways to discuss the various issues surrounding tube feeding and palliative care. But these specialized training opportunities or other ones like them are rare, and for the most part behavior analysts do not learn how to talk about hard topics with clients. When possible, I ask for guidance and defer to the judgment of clinical psychologists and other professionals who have extensive training in these matters. But because in my work some­ times I do not have time to reach out and await a reply, I offer this as a general rule of thumb: directly invite clients to transition from euphemism to direct communication. Let them know why you are extending this invitation. Offer it with care and respect their answer. They may want to continue wearing verbal protective layers at this moment and later shed them. They may remove these barriers today and put them back up tomorrow. They may take your lead and retire the shields once and for all. Or they may remove them with you and selectively remove them with others, depending on their audience’s level of maturity and need. This latter course is, in my view, the most sensible and the one to aim for. In some cases, you may work with a client who does not understand the euphemisms that others are using. With consent from other stakeholders, it may be important to teach what the euphemism refers to and offer guidance as to when to use it and when to drop it. Consider this short dialogue with Barb, a fifteen-year-old girl with mild intellectual disability whose older brother Phil has just died after being on a ventilator for some time. Barb:

My brother is moving on, you know. That’s what kids in school are saying.

BCBA:

I understand what you are saying.

Barb:

My friend Alisha was in his class at school. She said their teacher told the class they put Phil to sleep. He got lots of sleep on his own is what I told her, so I don’t really know.

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BCBA:

I thought this might come up. I’m very glad you are talking about it. You and I spend a lot of time practicing skills for building and keeping friends at school, so figuring out how to talk about this with your friends is pretty important.

Barb:

He’s just resting, my brother Phil.

BCBA:

Do you know what that means, Barb?

Barb:

[Sits quietly for a moment and looks down] My friend said he bought the farm, but I know he doesn’t have any money anyhow.

BCBA:

Everyone is trying to help you with this. Your friends are wonderful. They all care so much for you. They don’t want to see you hurting.

Barb:

What did Alisha’s teacher mean when she said they put Phil to sleep? He’s not even in his bed no more.

BCBA:

Your mom mentioned that you may need help and since this is coming up with kids at school and we are working on ways to manage friendships in school, this is important. Barb, can I give you the facts?

Barb:

Yes.

BCBA:

Phil was very sick. His body could not keep breathing on its own—that’s how sick he was. And you know that bodies need to breathe to stay alive. When you stop breathing, you stop living. It looks like you’ve gone to sleep, so that’s why people say, “He’s just resting.”

Barb:

He’s been sick for a long time. Long as I can remember.

BCBA:

They kept him alive as long as they could by helping him breathe with a machine. It pumped air into his lungs.

Barb:

Is that why he’s been in bed all this time?

BCBA:

Yes, Barb, that’s exactly right. But the machine stopped pumping air into his lungs. He stopped breathing, and that means he also stopped living. The simple way to say this is that your brother died.

Barb:

I don’t like that. He’s just resting is all.

BCBA:

Yes, that’s one way to talk about it. And that is a very smart way for you to talk about it with friends at school, Barb. What might you say when people ask you where your brother is?

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Barb:

He’s resting.

BCBA:

But the simple way of talking about it, the way I said before…

Barb:

My brother died when he couldn’t keep breathing no more.

BCBA:

That’s exactly right, Barb. Nice work.

The BCBA in this exchange worked to bring Barb’s behavior under differential stimulus control—that of school and that of a frank conversation between people close to the facts. Moving forward, it would be important for the BCBA to offer more training on the difference between school and home contexts. It seems useful for Barb to know the facts, but her friends may not have family support for hearing these facts addressed in plain terms, so it makes sense for Barb to speak euphemistically with them. This use of euphemism in school contexts is not experiential avoidance—it is discriminating social environments for their differential probabili­ ties of reinforcement for different ways of speaking. The BCBA here is wise in helping Barb with the facts and offering a way of speaking with friends that may want to talk with her about her brother.

Hyperbole Hyperbole is an outrageous exaggeration. You can use hyperbole to foster defusion that functions through frames of distinction. In other words, using hyperbole evokes a response such as, “Well it’s not that bad.” Simon:

I’m not going to study with you anymore. I got an F in math. I always get Fs.

BCBA:

It feels that way, huh? Like you got all the Fs. Like you got all the Fs in the whole world.

Simon:

Well, not that many.

BCBA:

Oh. Okay, so maybe it’s not that bad. Can you think of a time you didn’t get an F in math?

In this scenario, Simon is threatening to quit getting tutored in math and his BCBA uses hyperbole to evoke discrimination of different situations in which he did and did not fail. Many clients engage in black-and-white thinking that leads to abrupt termination of healthy behaviors when they do not get immediate gratification. Discrimination tasks such as using the ACT matrix can be enhanced by using hyperbole, as long as the therapist is sensitive to the feelings of clients and does not inadvertently invalidate or shame them.

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Irony Irony is a tool in which statements are made that one person recognizes are false but the other does not. This device can be especially useful with younger or less mature clients who understand only part of what you are saying. Hassan:

[Climbs under the desk] It’s too loud up there. Chewbacca and Buzz Lightyear are trying to take a nap. [Lays out his action figures beside him on the floor]

BCBA:

[Climbs under the desk with him] You’re absolutely right, Hassan. It’s too loud up there. Can I join you down here?

Hassan:

Really? Okay.

BCBA:

How could they be acting so loud right now? Don’t they know Chewbacca and Buzz Lightyear need to rest? They’ve been out saving the galaxy!

Hassan:

It’s not fair.

BCBA:

Totally unfair. But it is recess, after all. So, maybe they don’t know how Chewy and Buzz were out there trying to protect them. What do you say we give our heroes another minute to rest and then get them to go out and give a speech to all the kids out there about saving the galaxy? This is super important, don’t you think? Chewy and Buzz need a quick nap but then they need more heroes to get out there and help them. What do you say?

Promoting willingness is sometimes a matter of getting into the world of your client. In this case, the BCBA gets into Hassan’s fantasy world in order to invite him to reroute social avoidance.

Metonymy Metonymy is a figure of speech in which an attribute of one thing is spoken of as a stand-in for another. Skinner (1957) discussed metonymical extension as a response form in which the response has already been acquired in one or more of the elementary verbal relationships, the stimulus is novel, and the stimulus has none of the relevant stimulus characteristics of the stimulus class that had previously controlled the response. Thus, in saying “the kitchen is calling,” the kitchen is an irrelevant characteristic of the occasion that has gained control over the verbal response. This occurs because the stimulus (the kitchen) often accompanies the relevant features of the event (the presence of food and food deprivation for an extended period of time). Although early learners may use metonymy as a pattern of error in verbal behavior, in an ACT intervention, you may find it helpful to use metonymy to promote flexible perspectivetaking. Here is an example.

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BCBA:

We need to let everyone know that Premier Chamberlain, the leader of the galaxy, needs them. Are you ready to announce this to everyone out there?

Hassan:

I don’t think they know who Premier Chamberlain is.

BCBA:

That’s a good point, Hassan. We could simply tell them the message is from the galaxy.

Hassan:

Everyone! Everyone listen up! We have an important message from the galaxy. Chewbacca and Buzz Lightyear just returned from the outer reaches of the galaxy where they are fighting to keep our planet from being invaded. They need our help. Would you join Chewy, Buzz, and the Skywalkers to fight for the galaxy?

Metonymy used in this manner promotes deictic and hierarchical framing to achieve flex­ ibility in relating to others’ point of view. Others know the galaxy but not Premier Chamberlain. And Hassan knows that Premier Chamberlain works at the behest of a galactic council. Thus, because Chamberlain is part of the galaxy’s governing council and everyone knows the galaxy, the BCBA here is fostering advanced AARR perspectival skills that may then generalize to other contexts.

Oxymoron Sometimes a combination of two words that appear to contradict one another can be used for effect. My colleague Jonathan Tarbox tells of taking his four-year-old daughter to the amuse­ ment park and climbing a staircase to the entrance of the roller coaster. Just before getting into their seats, his daughter said she was frightened. Margo:

It’s scary!

Jonathan:

I know, huh? It’s super scary. But it’s also kind of cool too, don’t you think? Like we could be going really fast and still be perfectly safe. Scary and cool. It’s…scary-cool!

With that, his daughter repeated the word scary-cool several times and together, they climbed aboard the ride.

Paradox Paradox is a literary device in which an apparent contradiction is used to reveal an unex­ pected truth. Earlier, I described “back is the new forward” with respect to the analogical char­ acteristics of the context in which the statement was used. However, the phrasing itself is a useful illustration of a paradox, in which control over the use of one stimulus (back) is shared

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by the controlling features of the other (forward) and can be used to facilitate paradoxical action. This is particularly useful in aiding the transformation of verbal and stimulus functions from aversive to appetitive.

Personification Attributing human characteristics to an inanimate object, animal, or abstract idea is per­ sonification. This device can be used to generate flexibility in any of the ACT repertoires. It is particularly useful when promoting willingness around discomforting emotions, memories, and bodily sensations or defusion from sticky rules. In the following example, a BCBA uses personi­ fication to help a parent generate some flexibility around expectations. Parent:

I know, I know. These data sheets look like they’ve been through the washing machine. That’s grape juice on this one. Melted crayon over here maybe?

BCBA:

Collecting data when you’re running sessions with Ricky during the week is tough.

Parent:

I feel like I get boxed in by all the expectations.

BCBA:

I get it. It feels like we put a lot of pressure on you to continue work throughout the week that the RBT starts when she’s here.

Parent:

That’s for sure.

BCBA:

At the same time, you’re trying. It’s obviously important for you and you’ve made a commitment to doing it. The data help us know what to do next, so I’m appreciative of what you did to collect and submit here. Many parents never get this far, so this is very good. But I’m getting from you that you want to take this to the next level. Am I right?

Parent:

If it means better outcomes for Ricky, then totally. Yes.

BCBA:

You mentioned feeling boxed in by all the expectations. I wonder if we might try something with that. Imagine that right now, you’re conducting tact transfer trials with Ricky but there’s a load of laundry to finish and food to check in the oven. The expectations for real-time data collection, laundry, and oven are like a box you’re in and it’s getting smaller. Closing in on you.

Parent:

I feel that; for sure.

BCBA:

Right now, you feel it, yeah? So how about you look to the left, and look to the right, and out loud to me right now you say, “Box is here. Hello, Box.”

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Parent:

Okay, that’s weird. [Looking left and right] Well, okay now. Box is here. Hello, Box!

BCBA:

Hello, Box! I know you’re just trying to make sure I get things done. Can you maybe give me a little wiggle room, please?

Parent:

[Looking to her left and right] Hello, Box! Hey, I need a bit of space here. Can you ease up just a bit?

Pun Pun involves wordplay in which words under the control of different variables have similar or identical sounds. As is the case with other literary devices, puns can be used to promote flex­ ibility across any of the ACT repertoires. Here is a pun used to facilitate flexible selfing. BCBA:

The next thing is, how about we do something to protect the integrity of the data. What would you say to taking photos of yourself running the tact transfer trials with Ricky? This gives us evidence of the work being done and specific information of the contexts in which the trials are conducted.

Parent:

What? You want me to take pictures of myself? That’s just wrong!

BCBA:

I can tell you’re only half serious. But there is the half part of what you just said that is serious.

Parent:

For sure. I don’t much care for selfies.

BCBA:

Maybe we can use that. How about when you start up trials in a new context, you say to yourself something goofy to lighten up about yourself. Something goofy about selfies, maybe.

Parent:

I got one. How about, “Believe in yourselfie!!!”

Symbol Symbols are powerful nonverbal stimuli that are controlled by stimulus features of a broader context in which they are commonly found. Among other uses, symbols can be particularly useful in connecting values to action. For example, a child, dyad, family, or class can be tasked with coloring in a shield on oaktag paper as a symbol of their commitments to themselves or their group. A shield is commonly split into four to six quadrants, and each can be used as a frame for different aspects of the specified relation (see figure 6.1).

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Figure 6.1

Synecdoche In synecdoche, an element of a stimulus is used to refer to the whole. Constructing an effec­ tive synecdoche that occasions desired action requires a hierarchical framing repertoire. Consider this example with Simon, who’d been failing math: Simon:

But I still hate math.

BCBA:

Yeah. Too many digits.

Simon:

Yeah.

BCBA:

What if we call math Digits and think of fractions as Digging.

Simon:

Like when you dig out the parts of a jigsaw puzzle from the box? Awesome!

BCBA:

You know, it might work like this. You’re going into math class and it’s going to be a fractions day. You notice you’re getting nervous, so you say to yourself, “It’s Digging class. Going digging for parts.” What do you say?

Simon:

Awesome! I can do that.

BCBA:

Can you do something for me? When you’re on your way in to class this week, on fractions days, text me. Just one word. Text me, “Digging.”

Simon:

Cool!

In several of the last examples of literary devices, an emphasis was placed upon the issue of committed action, data collection, and data integrity. We will return to these issues in the next chapter on active exercises. Keep this table handy as a reference for ways to make therapeutic use of figurative language in session with clients.

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Common Literary Devices to Enhance Metaphors Device

Definition

Example

1

Allegory

A story, poem, or image with ambiguous characteristics that can be interpreted as hidden meaning

Lady Gaga’s “Applause” is an allegory for the power of artists to command audience approval

2

Allusion

A reference to some person, historical event, work of art, or mythological situation or character

Mentioning Sisyphus can be an allusion to our common, repeating life struggles

3

Ambiguity

Words or phrases that can mean more than one thing

ACT therapists may leave questions that clients ask about processes unanswered so that the ambiguity occasions active discrimination

4

Analogy

Overt comparison of relations in which one is familiar and the other is not

Life is a game. In most games, you go forward, but in life, sometimes you look back to move forward

5

Apostrophe

Speaking to a real or imagined listener or to an inanimate object

(Speaking to thoughts) “Okay people, move over. Gain way, please.”

6

Cliché

Common metaphors that are not evocative—unless enhanced with active exercises or other ACT strategies

Busy as a bee is a cliché that can be woken up by physicalizing the action of a bee with the client

7

Contrast

Closely arranged things with strikingly different characteristics

A steep boulder trail versus a wandering trail on soft underbrush

8

Euphemism

Understatement used to lessen the unwanted effects of words dealing with painful occurrences

They put my brother to sleep Taking an early retirement

9

Hyperbole

Outrageous exaggeration

I got all the Fs. All of them.

10

Irony

When one person recognizes a statement is false but the other does not

I know you don’t need a nap, but your action figures sure do. Let’s take a nap with them so they can get their rest.

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11

12

13

14

Device

Definition

Example

Metonymy

An attribute of one thing is spoken of as a stand-in for another

The kitchen is calling

A combination of two words that appear to contradict one another

Scary-cool!

An apparent contradiction used to reveal an unexpected truth

Back is the new forward

Attributing human characteristics to an inanimate object, animal, or abstract idea

Feeling boxed in, greeting Box

Oxymoron

Paradox

Personification

The White House has spoken

Definitely maybe

What you won’t have, you’ve got

Ms. Anxiety; Uncle Sadness

15

Pun

Wordplay in which words under the control of different variables have similar sounds

Believe in yourselfie! (Prompt to take photos documenting ABA task work)

16

Symbol

Powerful nonverbal stimuli controlled by stimulus features of a broader context in which they are commonly found

A shield can be drawn in four quadrants as a symbol of the strength of a family

17

Synecdoche

An element of a stimulus is used to refer to the whole

“The Committee tells me…” refers to many thoughts you are having at once

CHAPTER 7

Active Exercises

It is 9:30 p.m. Others in your house are settling in for the night. You are on deadline to get a series of assessment and intervention reports written. You turn down the lights that might keep others up and tap out a few paragraphs. Jezebel wakes up and cries out that she can’t find her bottle. You notice your irritation and briefly weigh putting this on attention extinction versus getting Jezzie a fresh warm bottle of milk. Meanwhile, the clock on your wall reports over and again with a relentless, steady tick. Feeling the familiar rush of heat against your cheeks, a slight throb against the outer edge of your eye, and a swell of thoughts about being a bad mom, you take two breaths, stand, close your eyes, and begin an exercise you’ve learned to perform when feeling pushed beyond your comfort zone. This sixty-second exercise calls for you to hold your arms high above your head and see yourself to be the picture of a tropical mango tree with limbs swaying in the wind during a dangerous storm. Wild rainforest mango trees grow to be over a hundred feet high and live for hundreds of years. Their limbs stretch upward, even bearing a hefty burden of fruit. During storms in the tropics, seventy-mile-per-hour gusts are common, and sustained winds during severe storms can take down power lines and houses. But throughout the most taxing of storms, the mango tree stands. Like the mango tree, you stand tall. A mango tree of your comportment is not immovable. It is supple, adaptive. Limbs bend with the wind; the trunk arches its back. In contrast, houses are inflexible. They cannot bend without detaching from their foundations. But in this exercise, your mango arms, held high above your head, sway freely with ripening fruit wagging from your fingertips. Your torso bends, but your feet remain anchored to the ground. You are pushed and pulled but you remain rooted to the nourishing soil beneath you. Nearby, utility poles snap and fly through the air. You remain, steadfast even if shaken, committed to your stand. After sixty seconds of this, Jezzie is still crying and you respond, rooted to your values. It might not feel good. And. You’re a mango tree. You stand where others fall.

Physicalizing the Metaphor In chapter 6, you learned strategies for highlighting and expanding metaphors clients use in everyday speech. You learned to capture these uses of figurative language so that they can serve as learning heuristics that clients will reflect upon when situations are difficult. Skilled

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practitioners reprise metaphors constructed with clients at key points across many sessions. But the extent to which clients make use of these heuristics on their own when they will count in daily life may be a matter of the degree to which they were spotlighted and used during carefully designed practice sessions. This is, in fact, the strength of a behavior analytic approach to bring­ ing about meaningful changes in client repertoires—we do not train and hope. Rather, we train, practice with prompting and reinforcement, set contingencies for further practice in our absence, reinforce when there is evidence that the behavior was emitted at the right time and place, and teach the learner to track the outcomes of using these new behaviors in context. In the illustration above, a mother noticing herself being pulled to respond in ways she knew would in the long run be harmful to her daughter takes sixty seconds to practice physicalizing a meta­ phor constructed during work she learned to do with a behavior analyst. The practice helped her recall her previously articulated values and evoke behavior consistent with those principles. This might have come about in the following way: Mom:

When Jezzie screams during the night and I’m working, I honestly feel like I’m going to snap.

BCBA:

Like a tree.

Mom:

Yeah, like a tree in a tropical storm.

BCBA:

Have you snapped before?

Mom:

Yes! I’ve gone and yelled at her. Or I’ve gone and gotten her what she wanted and laid with her until she’s fallen back asleep. Either way, it feels like I’m broken.

BCBA:

You know, you said something really interesting. You likened yourself to a tree in a tropical storm. I’ll bet you’re right. Some trees don’t fare well in gale force winds. You see it in the news—during a storm, trees fly through the air and houses get ripped from their foundations. But have you ever heard about trees that remain standing when everything nearby is pulled from the earth?

Mom:

What, like a mango tree?

BCBA:

I don’t know. Is that a tree that doesn’t get detached from its roots in most storms?

Mom:

Yeah, they say it’s more supple than most other trees. The trunk has more bend to it.

BCBA:

Good to know. This is new for me. I like this… What if we were to make use of this suppleness? Maybe we can try an exercise. This will seem a bit odd, but it won’t take long. If you’re willing, let’s both stand up. [Both standing] Now again, if you’re willing, close your eyes and try imagining that you are a mango tree in a tropical region. Wave your arms high above your head like

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the branches of this towering tree. A storm is kicking up and the winds are insane. But you’re a mango tree, so what do you do? Mom:

I don’t snap.

BCBA:

Brilliant! Instead, you—

Mom:

Sway!

BCBA:

What if right now, you were settled in to get some work done, everyone has gone to bed, and out of the blue, there’s a high-pitched wail coming from Jezzie’s room. She’s got some issue and, well, you can hear it in the quality of her voice that this is something she can manage without you and that if you go to her, you’re reinforcing a behavior that isn’t helping her or anyone else in your family. Can you hear it? That sound of Jezzie’s voice? That’s the wind tossing you around right now. Go ahead and move with it, keeping your feet firmly planted in place.

Mom:

So, my feet are like my values.

BCBA:

That’s fabulous, yes.

Mom:

This actually feels okay, surprisingly. I guess it’s good to get up and stretch, huh?

BCBA:

Yes. Now let’s you and me put on our behavior analytic glasses. This probably does feel good right now, but I don’t expect it’ll have any effect on your behavior four nights from now when Jezzie starts rousing you and her brothers unless you put this into some kind of regular practice. Like any other behavior, you’re going to have to practice the mango flex so that when it counts, you’ll use it. How about this: I’d like you to set a timer for yourself to go off twice a day. For sixty seconds, I’d like you to practice standing with arms above your head swaying in the wind and hearing Jezzie scream. Your feet remain planted in your values while the rest of you feels like it’s going to break, but instead, flexes.

Mom:

What do I do when it actually happens?

BCBA:

You tell me.

Mom:

I practice standing and flexing.

BCBA:

One last thing. When the wailing starts—would you be willing to videotape yourself? That way I can see you practicing the mango flex and get a sense of how long Jezzie’s tantrum lasts. If you do this repeatedly, we should see the duration of her tantrums begin to decrease.

In this exercise, first developed by ACT practitioner Hannah Bockarie (2016) from Sierra Leone, embodying a turn of speech with action is a step up from just discussing it in session. But

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the most important aspect of the intervention is neither the metaphor nor its physicalization in session. The applied behavior analysis that you are bringing to these techniques—repeated practice, measurement of actual dimensions of behavior (both the mom’s and Jezzie’s), an inspection of verifiable permanent products, and planned reinforcement of these behaviors when they have generalized into novel settings—is the aspect that is most likely to ensure favor­ able outcomes. In sequential order, the steps to making use of physicalization are: 1. Catch and cocreate a client’s metaphor. 2. Physicalize it in session, reinforcing successive approximations and effort. 3. Perform repeated practice by reprising the metaphor frequently. 4. Prompt and reinforce repeated practice in novel environments. 5. Plan to collect data on relevant dimensions of socially important behaviors. 6. Inspect verifiable permanent products. 7. Reinforce desired behaviors when they’ve generalized to novel settings. 8. Evaluate and decide what to do next. Here is another example of a therapist physicalizing a metaphor in session and calling for ongoing practice followed by action in novel settings. In this example, an interventionist strug­ gles with a younger client whose offensive comments leave her feeling self-doubt. The interven­ tionist’s supervisor, seasoned in ACT, walks her through pain into purpose using a physicalized turn of phrase the interventionist dashed out in passing. See if you can spot each of the eight moves in the dialogue: Interventionist:

I got into an argument with Adam today. It’s unprofessional, so I wanted to come to you and get some coaching. The kid grilled me on why I’m even in this line of work, and to be honest, it hurt my feelings.

BCBA:

I’ll bet it did. Hey, thank you for stepping up to talk to me about it. That is courageous and professional.

Interventionist:

It brought up some questions for me, like, am I right for this work?

BCBA:

Oh. Those questions.

Interventionist:

Those questions.

BCBA:

I’m no stranger to those questions. You know, I’ve asked myself those questions at times, too.

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Interventionist:

I tend to push them down.

BCBA:

Now that’s interesting. Where do you push them down to?

Interventionist:

I dunno. Maybe into my subconscious. Is that something behavior analysts can even say?

BCBA:

I don’t know, but you just said it. You said you push those questions down—wherever that is, when you’re done, they’re not out here [motioning to the table the interventionist is seated at] in front of you.

Interventionist:

Adam just knew exactly what button to push to bring up all my self-doubt, and that just triggered me to get into it with him.

BCBA:

You push this self-doubt down so that it’s not up here. That way you don’t have to look at it, which is a relief, except when it comes up, it’s scary to see.

Interventionist:

That’s why I push it down.

BCBA:

I wonder if we might try something. I think I can give you something to do that will help when you’re working with Adam. The aim is to train you in a few skills so that when Adam pushes your buttons, you continue asking him to work on his IEP goals and keep yourself from getting sidetracked into taking care of your hurt feelings. Does that sound okay? [Waits until the interventionist gives a nod of consent] Would you be willing to try doing something with me? I’d like you to imagine that your self-doubt were a thing and we could put it right here in front of us.

Interventionist:

I think it’s too big for the table.

BCBA:

Funny. Okay, we can move the table away. How big is it?

Interventionist:

Well, it’s at least as big as I am.

BCBA:

So, six feet. And is it rough or smooth?

Interventionist:

Spiked and sharp mostly, but you know, I guess there are some smooth spots. I mean, I don’t always feel like I can’t handle my work. Sometimes I just tap on it and it goes away.

BCBA:

And then what happens those other times?

Interventionist:

I can’t find where to touch on it to push it down. It’s all sharp.

BCBA:

What color is it?

Interventionist:

There’s a lot of dried blood on it!

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BCBA:

Okay, that’s scary. So, it’s brown—blood brown. How heavy is this thing?

Interventionist:

About 160 pounds. I know because that’s my weight.

BCBA:

I think I see it now. It’s like your twin, your uncertain self. It’s Dr. Doubt. Now sometimes you’re successful at pushing Dr. Doubt down. Let’s see if we can work with that a bit. Here you are sitting with me, and let’s say I’m Adam. Adam says something about you that hurts and out comes Dr. Doubt.

Interventionist:

Blood brown. Just out of surgery.

BCBA:

And you can push him back down, so go ahead and do that. Push on him.

Interventionist:

Okay…

BCBA:

But you gotta keep pushing on him. Don’t take your hand away, because if you do, uh! Yup. There he is, back here in front of you. So, keep your hand on him. Better push him way down.

Interventionist:

Like this? [Hand on the floor]

BCBA:

Yes, if you want him out of the picture. Because if you give him an inch, he’ll pop all the way back up. But keep your hand on him. Don’t let up. You can smile at Adam now. Just don’t lift your hand from the floor. Oh, wait though. You and Adam were going to play darts as a reinforcer. Now what? Don’t lift your hand or you’ve got Dr. Doubt…

Interventionist:

This is exhausting.

BCBA:

I’ll bet. Don’t raise your hand off the floor.

Interventionist:

I kind of need to.

BCBA:

You know what’ll happen if you do, don’t you?

Interventionist:

Dr. Doubt.

BCBA:

Dr. Doubt. That would be bad, huh?

Interventionist:

Well, I mean, it’s not like I’ve never been to this doctor before.

BCBA:

Hmm. Okay then. So, I wonder if there’s another way here.

Interventionist:

What do you mean?

BCBA:

I don’t know. What else is there to do, other than pushing down on Dr. Doubt?

Interventionist:

Letting him out?

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BCBA:

If you were to let him out, what would happen?

Interventionist:

He’d be in my face.

BCBA:

You’d kind of be forced to take a good look at him. And listen to him. What would he say if you stopped pushing him down?

Interventionist:

That I’m a loser and that I don’t really care, so I have no business being in this job.

BCBA:

And then you get into an argument with him about it, kind of like you did with Adam.

Interventionist:

Sort of.

BCBA:

I’m thinking that’s an argument you’re not likely to win. Adam sure knows where your buttons are, so I’m betting Dr. Doubt does too.

Interventionist:

What if he just never goes away and he’s always here?

BCBA:

Well, if that’s the case, would it help to get to know him a bit better? To get familiar with the things he’s likely to say so that it doesn’t catch you off guard? Can you use your notepad to jot down a list of things Dr. Doubt says?

Interventionist:

He’s pretty assaultive.

BCBA:

Write it all down. [Pauses] And now that it’s out there, take a good look. [Another pause] Is there anything else that’s not on the list that should be there? Any names he calls you? Because this is what Dr. Doubt really is. He seems like he’s 160 pounds, spiked, sharp, and blood brown, but when you get down to it, what he is amounts to just this—a set of things you’re apt to say to yourself about yourself. And just like scary movies, the more you see this for what it is, the less scary it is. Now I say that to you, that the more you look at what he says to you, the less scary it’s apt to be to you. But I don’t want you to take my word for it. I’d like to set this up as an experiment. Adam is going to keep pushing your buttons, right? And I’m not taking you off Adam’s case. So, Dr. Doubt is going to come back. How about over the next week, each morning, you begin the day by taking three minutes to look through this list. Add anything that pops up. Nothing goes away. Just get comfortable being with all the uncomfortable blood brown things Dr. Doubt has to say to you. For three minutes. In fact, if you would, I’d like you to record it. Each morning. You can share the recordings with me when we meet again, next week, and based on whether this has helped you to be more effective with Adam, we can plan then for what to do next. You’re doing great, by the way. I notice your eyes haven’t left the page of Dr. Doubt.

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And I’ve got one more thing for you to do. How about you make a copy of this list you wrote up and put it in your pocket when you go to Adam’s house? Adam is going to keep pushing your buttons. When he does, lower a hand over your pocket and touch Dr. Doubt. You’re touching him not to push him down, but to get close to him, to pull him in. Adam can’t say anything worse to you than Dr. Doubt does, so this is just a way of familiarizing yourself with the worst of the worst. And of course, whatever Adam says is going to hurt. That’s why you’re getting familiar with the gist of what he has to say. You’re preparing yourself, and if he starts in on you, you touch base with Dr. Doubt. Interventionist:

Like taking medicine.

BCBA:

Like swallowing a pill.

In the chapters that follow, keep an eye out for physicalized metaphors and the use of the eight-step framework detailed above. You will see examples of this throughout the next six chapters, in which each of the ACT repertoires is discussed in behavioral terms, examples are provided, and a set of competencies are presented with exercises for you to develop your reper­ toire. Use this framework in exercises that call for more elaborated responses.

CHAPTER 8

Willingness

Eve worked with nineteen-year-old Alexa on targets related to personal hygiene and homework completion three days a week. Eve was having difficulty assisting Alexa, whose body odor, dis­ organized loose-leaf binders, and intense tantrums make her an easy target for peers to ridicule. Alexa lived semi-independently in an apartment connected to her parents’ family home. When Eve and Alexa set goals for their sessions, Alexa was enthusiastic, but as soon as things got dif­ ficult for her, she tantrummed uncontrollably. Her tantrums were loud and could last for the duration of their session. Since Alexa’s apartment was adjacent to her parents’ place, Mrs. Kaminski had knocked on the door a number of times and cast a stern look that Eve interpreted as a negative judgment. Eve worried that Mrs. Kaminski would complain to the BCBA on the case that Eve was ineffective with Alexa. Eve was no slouch. She was a BCaBA with over five years’ experience. Along with the BCBA on this case, Eve had conducted a descriptive functional assessment and hypothesized that Alexa’s tantrumming was escape-maintained. She set out each session to build behavioral momentum, used task interspersal, and reinforced desired approximations of Alexa’s behavior. In other words, she did all the right things. Usually. But there were times when Eve heard something in Alexa’s voice that reminded her of her own painful experiences getting tutored by her older sister in math. Her sister was verbally rough with her, and even though Eve was not rough with Alexa, she began to equate Alexa’s cries with her own. On top of this, Eve had a complicated pregnancy and her own daughter was born with a developmental disorder for which Eve sometimes blamed herself. Alexa’s tantrums, Mrs. Kaminski’s glaring eyes, and Eve’s memories of her sister’s rebuffs all seemed to her to be part of something bigger—a deep sense of inadequacy that terrified her. It was so frightening to her that on some days, Eve gave in and withdrew task demands that were within Alexa’s ability to accomplish. Eve didn’t say a word of this to anyone. Instead, she entered into a tacit agreement with Alexa, who stopped her tantrums and sat quietly while Eve busied herself with paperwork. She felt loathsome in these moments, but when the session ended, she would pull out her phone, dial a friend, and until the next session like this one, Eve submerged her feelings of self-doubt, worry, and self-loathing. Regardless of how we handle ourselves in these kinds of situations, you and I will often feel very similar to Eve. We get triggered by our own and others’ evaluations of us. We worry that we will be expelled from our jobs or our social groups. We see ourselves as imposters on the

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brink of being discovered. These concerns are pervasive and, sadly, not often openly talked about in training programs for ABA practitioners. The challenge of providing ABA services to others is that your job is about control— changing conditions to alter the course of overt, observable behavior. But applied to your inter­ nal experiences, control is an unserviceable goal. It is a game you can’t win. When Eve entered into this complicit agreement with Alexa, she was trying to control the internal content of her own emotions and memories and Alexa’s, too. And the insidious fact is that it seemed to work—for the moment. Alexa calmed down and no one came knocking on the door. Of course, Alexa also didn’t get any better at brushing her teeth, laundering her clothes, or organizing her binder, so the taunts from other kids increased. Eventually, the inef­ fectiveness of Eve’s interventions with Alexa became the focus of her BCBA’s negative attention. Fortunately, this play had a second act. Willow, the BCBA on this case, asked Eve questions about her experiences with Alexa that led to Eve opening up about the way she had been avoiding Mrs. Kaminski’s evaluations, Alexa’s emotions, and her own dark memories. Willow offered Eve a simple clarification and an exercise to perform with simple data to collect each day before going in to see Alexa. First, Willow explained to Eve that getting into power struggles with Alexa and giving in to her are both two sides of the same coin—they are both part of the control agenda. When control is the aim, the tactics invariably include dominating or avoiding because doing so has in the past resulted in a win by getting the other person to do something immediately. And in both cases (being harsh or lax), the interventionist with a control agenda temporarily avoids the aversive private experiences of shame, fear, and memories of failure. But avoiding private expe­ riences in this manner can come with a high price tag—if repeated, it results in a loss of effec­ tiveness over time. Next, Willow suggested that the alternative is to work with a shaping agenda. When shaping is the goal, nothing is forfeited by leaning into an ABA goal, even when it is so challenging that the learner acts out. In the presence of a coercive client or the client’s distrustful parent, the shaping agenda calls for kind but firm resolve to conduct the ABA session as planned or to change the plan in a way that fosters learning through contact with some measure of positive reinforcement. Guided by a shaping agenda, Willow explained, the focus for Eve would not be on winning the interaction, but on setting the stage for desired performance to develop over time. Finally, Willow asked Eve to take a coin from her purse and hold it tightly in her hands in front of them. She asked Eve to imagine that on one side of the coin there was a cold and baleful way of doing ABA and, on the other, an indifferent and lax one. These two sides of the coin represent the control agenda, in which the aim is to make sure she wins, and neither she nor Alexa expresses difficult memories, emotions, or bodily sensations. Willow asked Eve if she would be willing to gently lay this coin on the table and role-play setting expectations with a difficult “Alexa.” After their role-play, which was funny even if stressful, Willow asked Eve if she would pick up this coin and hold it in her hand for a moment upon arriving at her car each day

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that she works with Alexa. Willow handed Eve a simple frequency data sheet with which to keep track of her performance of this exercise, and then said that each day, Eve now has the choice to set the control agenda down on the dashboard of her car before going into the Kaminski residence. The control agenda will always be there if she wants to pick it up, but if she chooses to let her behavior come under the control of the shaping agenda, Eve will have the highest probability of success in the long term.

The Importance of Willingness Behavior analysts use a variety of techniques to jump-start and maintain behavior in the pres­ ence of aversive stimulus events. Behavioral momentum strategies, errorless discrimination, and stimulus and response fading are just a few of the tools that help generate behavior that contacts positive reinforcement. With many learners, particularly those who show more limited verbal skills, these strategies reduce unwanted sensations, emotions, and memories so that more optimal behavior can be emitted. But for other clients, covert behavior occurs simultaneously with the contingencies that behavior analysts program. Private behavior that undermines direct contingency control is called experiential avoidance—the effort to regulate, minimize, or eliminate unwanted private events. Covert attenuating responses probably facilitate overt escape and avoidance by setting the stage for and reinforcing actions that successfully reduce aversive stimulation. In other words, private avoidance responses can serve discriminative and conditioned reinforcing func­ tions in a behavior chain wherein both private and public behaviors produce a terminal reinforcer. To illustrate this point, consider the previous example in technical terms. There is an establishing operation of both painful consequences for representing task demands to Alexa and the current distress of anxiety in this situation. The latter is worth closer inspection. Eve has been reinforced in some situations for extinguishing escape-maintained tantrums and pun­ ished in other situations, and this made her feel anxious. Skinner (1953) suggested that anxiety is respondent behavior, such as sweating and increased heart rate, following behavior that has in the past produced either reinforcing or punishing consequences or some combination of the two. When it is unclear what the outcome of current behavior is going to be, we feel anxious, which can come to occasion aversive verbal behavior such as the construction of Eve’s state­ ment, “I can’t bear this.” Along with the competing aversive contingency, this covert response likely interfered with programmed contingency control over Eve’s behavior and set the stage for an avoidance response that terminated her anxiety. Over time, the thought “I can’t bear this” probably also served conditioned reinforcing functions in that it occurred as soon as she saw paperwork that she could busy herself with. Behavior analysts cannot be sure that a specific covert behavior such as this occurred, even with an employee like Eve telling us that she had that exact thought. We do not have to tools to amplify and measure her low-magnitude, private responses. Nevertheless, thirty-five years of

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evidence collected in RFT labs suggests that due to a history of reinforcement for manipulating the physical world to reduce exposure to threats, verbally competent humans engage in derived relational responding and extend avoidance to all internal experiences. Eve didn’t just avoid having to explain Alexa’s tantrum to Mrs. Kaminski; she also avoided the anxiety that she experienced in the past when she had to do that. Adding to the difficulties, Eve might have thought out a set of reasons that rationalized and even justified her actions. These behaviors help maintain experiential control over her anxiety by forming relations of equivalence that cohere with her action. A statement such as “It’s the only thing I can do in these situations” is a supplemental verbal stimulus that would help ward off other aspects of the internal dialogue that could pop up, such as the thought “I’m not helping Alexa.” Such thought suppression strategies are ubiquitous, and even taught by many psychologists. The problem is that when thoughts are very sticky, suppression is generally unsuc­ cessful (Abramwoitz, Tolin, & Street, 2001). For this reason, willingness is a strategy that counteracts the excessive and misapplied effort to control internal experience. It is important not only because thought suppression is generally unsuccessful. It is also important because of the pervasiveness of uncertainty and discomfort that co-occurs with values-directed behavior. In other words, we hurt where we care. Willingness to be open to the full range of your experience while also actively moving toward your values is a difficult concept to explore with clients. Some misconceptions due to the connotations of words that willingness and acceptance carry are important to disambiguate. First, willingness does not imply that people need to want to feel or think or remember the things that surface. Many experiences that emerge when taking valued action are challenging. Turning to face the pain is like opening the door to let in fresh air. The air could be cold or very hot, but it is vital to life. The act of allowing what is present in one’s life to be there even if it is unwanted is willingness. Sometimes the word is used in an experientially avoidant manner in the context of unavoid­ able life events. Parents of children with autism are taught to accept this diagnosis, jilted lovers that their relationship is over, and bereaved partners that their loved one has passed. There may be wisdom in any one of these caring pronouncements, but it is a dangerous misunderstanding if the individuals who hear this caution take it to mean that acceptance will take away their pain. If the pain returns, then the person experiencing it must be defective, because after all, they have already done what they were told to do and accepted their situation. Acceptance as it is understood in ACT does not imply that pain, anxiety, anger, or unwanted memories will be removed. Rather, it means that these experiences will be recontextualized as the price of admis­ sion to a life of purpose. Rather than resignation, a better way of understanding willingness is that it involves an action of gently embracing thoughts, memories, bodily sensations, and emotions without trying to change them if they emerge in the context of doing things that matter. In Eve’s case, the practice of laying down the urge to be lax or harsh toward Alexa makes room in her arms to embrace the difficulty inherent in her job so that she can leave at the end of her sessions

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without having to quickly call a friend and escape the thought that she is inadequate. After a few trials, embracing these challenges is an action that is selected by her history because it pro­ duces a larger reinforcer than escape or avoidance. Willingness results in a work life that honors a possibility that Alexa’s life will improve and values the many years that Eve spent training to earn her credential. In this way, willingness is not about resignation: it is life enhancing and empowering. On this last note, it is important I say a few words about serving parents of children with autism. BCBAs sometimes receive funding to provide parent training. If you find that direct contingency management with parents is difficult, you are not alone. Many BCBAs working in the field of autism services find this the most challenging aspect of their work. In part, it is because BCBAs do not hold the contingencies to which parents respond. We have no extrinsic reinforcers to offer them until appetitive natural contingencies take control of their behavior. Parent behavior is largely under the control of their children’s behavior, and they may be uncon­ sciously caught in a negative reinforcement loop similar to the one that Eve and Alexa were caught in. But Eve and Alexa were not only responding to each other’s behavior. They were also responding to indirect-acting contingencies, or in common terms, they were caught up in their heads. Parents are like this, too. Almost every mom and dad I’ve ever met struggles with the thought that “I’m a bad mom” or “I’m a bad dad.” But with parents of children with autism, this is compounded with grief, an overwhelming heartache over the loss of the child they thought they were going to have and did not. This sorrow could be weighed down further with other feelings, such as guilt, shame, and loneliness (more on this later). Even though ABA practitioners do not practice psychotherapy, it is important for interven­ tionists to be skillful at working with parents experiencing grief and other hard emotions. This can seem difficult because many cultural traditions teach their young to hold grief at a distance. Children are often taught that it is either not okay to feel sad or that they need to get over it and move on quickly. For adults, there is an unspoken shame that accompanies lingering grief. It is permissible in small doses for brief periods of time after a tragic event, but any prolonged or returning sense of sorrow can occur as dangerous or weak. Most of us get scant training in how to manage our own grieving, let alone that of others with whom we work. The ACT stance is one of openness to the experience of sorrow, whether it is one’s own or someone else’s. When anguish is someone else’s, it can be deeply disturbing because it threatens to unleash your own suffering. It is easy to recall and reexperience your own traumatic events when being close to someone else experiencing theirs. It is understand­ able that we avoid these subjects with others lest their anguish rub off on us. Because treating bereavement is not within the scope of practice of a BCBA, it is an easy out to simply stick to the business of managing direct-acting contingencies. But this can come across to parents as cold or insensitive. Moreover, if direct contingency management is not resulting in parent engagement with the work at hand, then some change of tack is warranted to bring behavior under the control of relevant direct contingencies.

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One such tack is willingness. Acknowledging another’s pervasive sense of loss can be a very powerful first step in helping them reorient to their lives. It does not have to be a lengthy, drawn-out affair, nor should it be. Simply giving a parent, or for that matter a child who is strug­ gling, a moment to be right where they are is an act of compassion that has many benefits. The parent is given permission to be human and learns in the process that you are not going to try to make them do any intense emotional work in order to change them. A willingness interven­ tion with a grieving parent can be very brief and subtle, as the examples below will illustrate. The importance of it is that it sets the stage for confronting the system. That is, willingness to be present to pain is a direct challenge not to the person, but to the cultural traditions that promote avoidance of difficult private experiences. Cultural agents such as parents, schools, teachers, doctors, and lawyers subtly transmit the message that pain is bad and has to be removed. ACT practitioners would never suggest that pain is good or that anyone experiencing it should be happy about it. But there is a wisdom to learning how to learn from it and sitting with it that a BCBA can model. Living this life, here, not the one a person thought they would or should be living, is a courageous defiance of the cultural maxim to always be okay. Teaching willingness, you empower the people in your midst to grow through their experiences rather than try to escape them. By confronting this system, a parent can learn to shift from a control agenda to a shaping agenda.

Functional Assessment of Willingness Deficits Card players learn to read their opponents’ “tells,” which are bodily habits and expressions that reveal something about the cards they are holding. The tells for behavior that is tightly con­ strained in the presence of aversive stimulation include observable gestures, such as pursed lips, clenched muscles, and folded arms. Experiential avoidance is observable in one’s tone of voice when it is clipped, muted, or, on the other extreme, elevated and aversive. But it can be masked too, by a superficial and breezy quality that deflects talk of more intimate and difficult things. Verbal cues include statements such as, “The emotions I feel when my son cries are too much for me to handle,” “I get these thoughts and that’s when I watch porn—to get a release,” or “I remember the pain I felt the time he head-butted me and I just freeze.” A critical verbal trap to be on the lookout for is a quality of dismissiveness to mentions of hurt or discomfort. Experiential avoidance is often masked with statements such as, “It’s nothing,” “I got this,” or “I’ll just suck it up and deal with it.” Any of these could be true in some circumstances. After a poor grade on a weekly spelling test, a learner can come to session with an ABA therapist, show a bit of upset, and get right into gear. But trivializing statements about being bullied or teased can be a warning sign of the kind of avoidance that could lead to pas­ sivity or aggression. Interventionists who consult in schools are in a good position to monitor behavior during recess, lunch, and on the playground for isolating, tolerating, or physically retaliating against the behavior of others. Those who work in homes or afterschool centers may see some of this from siblings or other service recipients. Even with limited interaction, it is

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possible to watch for downcast eyes, sunken shoulders, and other behaviors commonly associ­ ated with difficult private experiences. A flippant response to probing questions is likely a sign of experiential avoidance. Parents and professionals may reveal a proneness to experiential avoidance that is hidden under statements regarding the age of the children they care for. Statements such as “He’ll grow out of it,” “She’s just at that age,” or “Every kid goes through this” often conceal an unwilling­ ness to witness a child’s hurt. Children flourish when they are guided through these experi­ ences, and not necessarily from counseling professionals. Any parent, aide, or interventionist can show regard for the hurt, reflect that it is understandable to feel that way, and offer a little time for the child to experience what they are going through. The shaping agenda begins when adults model openness to the difficulty in rising to life’s challenges. In this, an adult’s insight into the developmental stage a child is at is crucial. Using language and metaphor that a child understands to assess their level of avoidance is the first step. Interventions appropriate to the child’s level of cognitive and physical development follow directly in that vein.

The General Approach to Treating Problems with Experiential Avoidance Regardless of the age of a client, the general strategy is to 1) draw out the many ways that person has tried to get rid of troublesome internal experiences, 2) expose the unworkability of these strategies, and 3) introduce structured practice that facilitates committed action. In ABA prac­ tice, this can be done very rapidly using the matrix and metaphors that the client and you generate together or established metaphors that you prepare to use in advance.

Drawing Out the Control Agenda Often the individuals who will benefit most from experiential willingness interventions have tried many tactics for disappearing their hurt. Many of these strategies are overt, and some are quite healthy. For example, eating healthy foods and going to the gym are great ways to approach moments in life when the stressors of ABA work are weighing heavily. However, if the goal is to eliminate the stress that comes with paperwork deadlines, leading IEP meetings, or tabletop instruction with a child who pinches delicate body parts, the payoffs aren’t going to match the expectation. Working out and eating nutritious foods are not going to make stress go away. The control agenda is insidiously targeted entirely on this outcome and anything short of stress elimination will not only fail but will produce more stress as the establishing operation doesn’t disappear. Other strategies may be beneath the level of awareness and equally unsuccessful. For example, oversleeping the alarm may not be an intentional way to miss or end up late for work, but if the function of this behavior is that it sets everything back and something regularly

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scheduled, likely something aversive, has to be rescheduled or shortened, then the ABA practi­ tioner’s aim is to expose this unconscious payoff to the client. Skillful management of these interventions involves targeting the system, not the client. The client should experience the therapist’s efforts to draw out the control agenda as a caring, concerned discovery process. It is possible that a client will feel threatened and behave defen­ sively in the process. In these situations, the therapist is advised to remain nonjudgmental and interested in the observations of the client. Saying something like “This seems to be more of the same effort to get rid of things that are difficult for you” might trigger more defensive reactions. In contrast, imagine hearing this: “I’m truly sorry that you experience it that way. Let’s take a step back from this and see it from another angle. It’s important to me that you know I get hooked in the same way. The things I do when I get hooked by avoidance might be a little dif­ ferent, but the end is always the same—my tactics fail, I try the same thing harder and more frequently, and I never get anywhere. That’s where a few willingness moves that I can show you come in. But the effort to get rid of stuff that hurts is completely natural. In fact, I’d be worried about you if you didn’t try any of these things.” This tactic serves to expose the control agenda and its unworkability.

Exposing Unworkability For willingness to be meaningful, it is important that the unworkability of control be fully revealed. This can be difficult to accomplish because control tactics often do work—in the short run. Certainly, Eve would say that busying herself with paperwork and phoning friends immediately when leaving her sessions with Alexa served to ward off her experiences of fear and shame. It wasn’t until her supervisor reacted to the intransigence of Alexa’s treatment out­ comes that Eve’s control strategies showed their unworkability. When clients point to the way their strategies are working for them, a gentle, nonjudgmental request such as this can help: “Now what if we were to fast-forward a bit and see how this ends for you if you stay at this for another year. Would this still be working for you?” Another way to expose the unworkability of the otherwise effective short-term solution is to ask, “And in doing this, are you finding yourself doing all the things that make your life meaningful, or are you noticing that there are a number of things that you can’t do, places you shouldn’t go, or people you must avoid to keep from feeling bad?”

Introducing Structured Practice and Committed Action Once the costs associated with experiential avoidance are clear, it is time to offer two dis­ tinct exercises for the client to regularly practice, each of which should be measured with a data collection system. Process interventions focus on inducing willingness with increasing duration and magnitude. Context interventions are direct contingency management efforts that begin or maintain ABA target performances—socially significant, observable, measurable behaviors. It

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is important that ABA practitioners employ both types of interventions. The aim of using ACT in ABA should be to bring behavior under the control of direct contingencies of reinforcement. To this end, skillful application of experiential willingness strategies can be of value.

Using the ACT Matrix to Induce Experiential Willingness The matrix can be used to draw out control efforts, underscore their unworkability, and design ongoing interventions. In the following dialogue, a regional clinical director works with a BCBA who has fallen behind on paperwork. Throughout the exchange, the director is respectful and curious about the experience of her employee. Director:

Alain, I was wondering if we could chat for a few moments about your paperwork flow. During the sessions I observe, you seem to be consistent in execution and data collection, but I’m still noticing that you are behind on monthly and quarterly reports. We had a chat about this three months ago, and I shifted scheduling around to help.

Alain:

I know, and I appreciated that a lot. It helped, for a while. You also asked if there were some shifts I preferred over others and offered those as a reinforcer if I got the reports in to you on time.

Director:

That seemed to work for a while, too. What happened?

Alain:

I don’t know. I think I’m struggling with losing my focus. I don’t really understand it; I don’t have an overwhelming caseload like people at other companies. But I start feeling like I’m in over my head and then I obsess about it and then I start to panic. I can get on top of this, though.

Director:

It’s encouraging that you say you can get on top of this. Would you mind if I drew out a matrix with you so that we can see a little more of what’s going on here?

Alain:

The one you showed us in staff meeting?

Director:

You liked it, I recall, right? It’s a good tool for uncovering difficulties that are difficult to program for with the contingency management tools you’ve seen me use.

Alain:

Sure, but we used it for office cultural design back then. This is different.

Director:

Well, let’s see how this goes. I’m going to write down some of the things you said so far. You said you struggle with focusing and don’t understand. I’m putting that in the lower left corner. You also said that you don’t stay on top of paperwork. That’s why we’re chatting now, but I like the way you phrased it—staying on top of paperwork is tough for you—so I want to write it just like that. Now, can you tell me specifically what things happen when you start to lose your focus?

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Alain:

Well, I forget things. Like I forgot to grab my box of materials before leaving Gregory’s house the other day and then I was late for my next appointment. It’s like I’m the dude who’s going to leave my kid in the back seat of my car (except I don’t have any kids yet).

Director:

Okay, let me ask you this: there’s something about this job that truly matters to you. You could’ve just gone on being an RBT, but you didn’t. You went back to school and became a BCBA. What is it about this that captured your interest?

Alain:

Oh, that’s a good question. I think I really like being able to solve problems and give everything to my clients. I like being a compassionate problem solver!

Director:

Awesome. I’ve added all that to the lower right corner of the matrix. Well, given that, in the best of all possible worlds, if you were being the best of all possible Alains, what would I see you doing?

Alain:

I’d be doing all of the things! I’d be jamming with the most challenging clients and I’d also be staying on top of the billing and paperwork.

Director:

That’s great. I’m putting that here in the upper right part of this grid. What else?

Alain:

My materials and paperwork would be organized on my computer and desk, too.

Director:

Great. Now let’s take a moment to talk about what I’m seeing now. You say you’re going to get on top of it, but if you don’t, what am I going to be seeing, say, six months from now if this keeps going the way it’s going?

Alain:

Cripes, it’ll all be falling on top of me instead!

Director:

Ha! I get it.

Alain:

Can I be honest with you? That’s like my biggest nightmare. Every time I start working on, say, a big quarterly report, that’s what I think about and it’s like I obsess on it and then I look at my watch and I’ve spent an hour just thinking about it and not writing a thing.

This brief interaction illustrates the way a skilled supervisor can use the matrix to rapidly assess the indirect-acting function of an employee’s behavior. Note that the director had already unsuccessfully tried a number of best practices in supervision before asking questions concern­ ing verbal traps that could be in the way. The next step is to make use of one of the metaphors that Alain used in his speech. There were a few that Alain used, and any of them could have been valuable. But Alain used one turn of phrase repeatedly, and that is the one this supervisor chose to zero in on and physicalize.

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Director:

And when you’re obsessing, that’s when you start to feel like you’re in over your head and so you escape by…

Alain:

By zoning out, grabbing coffee, talking to my friends…

Director:

I get it. It sounds very familiar to me. I’ve gotten behind before. During grad school, I found myself working on side projects more than my master’s thesis. My thesis was important to me and to my advisor, whom I really didn’t want to let down.

Alain:

That’s kind of how I feel about you.

Director:

Totally understandable. You know, Alain, you’ve used a metaphor a number of times now and I want to underline it for a second. You said that you feel like you’re in over your head, so you step out for coffee and chatting with your friends and before you know it, you’re behind. Did I get that right?

Alain:

Yes, exactly.

Director:

So that feeling of being in over your head. I want you to try something a little weird with me for a moment. Try putting your hands up over your head to stop the weight of the reports that are due from crashing down on you. If that weight were to come crashing in on you, would your hands be able to stop it from beating you down?

Alain:

I don’t think so. There’s one report right after the next. I can never seem to get on top of them all.

Director:

Yeah, so you can’t get out from under this by shielding yourself. And that’s when you step away.

Alain:

Right.

Director:

And when you do, say, when you go and hang out by the coffee machine, do you ever really get away from the overhanging mountain of paperwork?

Alain:

Not really.

Director:

No. In fact, it’s a little like this. Here. Take this rubber band and wrap it around your wrist like a bracelet. I’m going to do it too, because as I told you, I can get stuck under paperwork too. Now I want you to simulate stepping away from this overhanging mound of work that you can never really get out from under by pulling on the rubber band. Got it?

Alain:

Pulling.

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Director:

Good. Me too. Now the longer you step away from your work, the more tension we’re going to put on this rubber band. Go ahead and pull just a little more.

Alain:

It’s gonna snap.

Director:

Exactly. That’s what’ll happen if—

Alain:

If I keep doing what I’m doing.

Director:

Yup. Now there’s another option here and I’m pretty sure you can figure out what that is.

Alain:

I can grab my coffee and go back to my desk.

Director:

Right on. And even back at your desk, you might start to let your mind wander off when the thought that “This is too much; I can’t get out from under it” shows up.

Alain:

So, I put on the rubber band even when I’m at my desk obsessing and daydreaming.

Director:

What can you do in these moments?

Alain:

I get where you’re going here. I can pull on the rubber band and slowly let it go without snapping it by easing myself back into my work.

Director:

And maybe giving yourself a sip of coffee as a reinforcer, right?

Alain:

Cool.

This exercise served to further expose the mechanisms of Alain’s control agenda and its ultimate unworkability. It’s important to observe that the supervisor has offered a self-disclosure in saying that she has had similar troubles in the past. She is even suggesting that she could get stuck in the same way today, and so she positions herself right next to Alain, doing the same trick with the rubber band. After this, she’ll seal the deal by suggesting process and context interventions and a way of measuring progress over time.

Building Exercises to Facilitate Willingness The kinds of exercises that a skilled supervisor or BCBA can come up with are truly endless. The chief element in dealing with experiential avoidance is that the exercises should flesh out the control agenda and its unworkability in a way that reorients behavior toward actions that produce reinforcement of a greater magnitude, even if delayed. A second factor is that the inter­ ventions should be available for monitoring. In the case of an employee, this can include selfmonitoring and data collection and oversight by the supervisor. Two of the most effective exercises are physicalized metaphors and guided imagery. Let’s look at each in turn.

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Physicalized Metaphor Physicalizing metaphors that clients use in their speech helps make client covert behavior more available for inspection. In the following dialogue, the director introduces a rubber band as a tactile way for Alain to remember to return to his work when his mind wanders. Director:

Well, here we are, both wearing a new rubber band bracelet. I’d like to ask you to engage in a little experiment with me over the next few weeks. We can track the results together. For the next two weeks, I’d like you to keep this rubber band on when you are here in the office doing paperwork. Any time that the weight of it all begins to feel “over your head” and you step away from your desk for longer than five minutes, I’d like you to pause and tug on the rubber band. You have the choice at that moment to gently return yourself to your work. If you stay away from your work, you’ll tug a little harder on the rubber band. The aim is that you begin to selfmonitor your behavior and bring yourself back to the task at hand more rapidly than you have been recently.

Alain:

I think I can do this.

Director:

Now it’s the same thing if you notice your mind wandering at your desk for more than five minutes when you are working on one of the reports that’ve been tough for you. Notice, tug, gently release, and return to work.

Alain:

And take a sip of coffee.

Director:

Or water. Definitely. The reinforcer is somewhat symbolic, but you might notice it gaining in strength for you over time.

Alain:

Wouldn’t it decrease in potency as I satiate on the caffeine?

Director:

Sure, if caffeine is the terminal reinforcer. But we’re not using it that way. We’re using it as a symbolic conditioned reinforcer. It’s a partway point en route to the real terminal reinforcer, which is—

Alain:

Submitting the next report on time.

Director:

And honestly, Alain, I’m going to be doing this too. But there’s one more thing, and that’s data collection. I’d like you to keep track of the duration of your breaks. You should plan for two fifteen-minute breaks per day in addition to your lunch break when you’re here in the office. Anything on top of that I’d like you to time, using a duration data sheet. I’d like you to do your best to monitor daydreaming and obsessing the same way.

Alain:

I think I saw some studies on workers tracking their off-task behavior. The selfmonitoring by itself was effective at strengthening on-task performance.

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Director:

Well, so this is really a package intervention, isn’t it? It’s self-monitoring plus an ACT component. If it goes well for both of us, you can fade the self-monitoring and I’ll fade the ACT component. It’s not a full-blown ABA experiment, but we already have data suggesting that some direct contingency management procedures that we’ve tried already didn’t work by themselves. So, this gives us a little more information about what might work with you and me in our situations.

Alain:

I like it. And thank you for doing this with me. That makes this a little less aversive for me.

Self-monitoring is often a strong direct contingency management strategy. In this case, the director used self-monitoring in combination with a physicalized metaphor to bring about changes in Alain’s behavior. Alain expressed willingness to confront his own control agenda and to try out this exercise over the course of the next two weeks. The director has many options to pursue at the close of the “experiment,” and can easily stop in over the next few days to ask how things are going and share progress.

Guided Imagery Another important strategy is guided imagery. When guiding a client to imagine an event, behavior analysts sometimes invite the individual to close their eyes and see it as though it were a movie playing against the screen of their closed eyelids. Guiding a client to see themself in a variety of circumstances provides a context for discriminative responses that help the individ­ ual observe their unhelpful thoughts without judgment and without any effort to eliminate them. Guided imagery is not always practical in ABA settings. It is a technique that should be used with caution because some could easily view it as outside the scope of practice of a behav­ ior analyst. If not properly contextualized, guided imagery could be misunderstood as a tech­ nique more geared for use in psychotherapy. It can also come across as lacking in the tight connection to basic principles of learning that characterize applied behavior analysis. Exercise particular caution in using guided imagery when there is a lack of trust with the therapist or during individual supervision sessions with employees. Make certain when using guided imagery that you clarify the purpose at the outset and link it back to other known procedures in ABA. For example, a preteen named Arif who is struggling with going back into the lunchroom after asking a girl named Rachel on a date and encountering rejection could be trained to approach the situation using guided imagery by an ABA therapist who makes this kind of prefatory comment: Arif, in behavior analysis we sometimes use a strategy called “graduated exposure.” You know how some kids feel very frightened of certain textures of food, like the feeling of broccoli on their tongues? To help kids like this, we set up a series of situations where

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they slowly get closer to these foods, touch them with their fingers, take a little on their tongues, and so forth until they can eat whole stalks of broccoli without feeling agi­ tated. In your situation, it would be weird to go into the lunchroom, then leave, come back, leave, and come back again. So, to help you, I recommend we try using guided imagery to accomplish the same goal. This could be safer than you just “white knuck­ ling” it and going into the lunchroom without any prep for the feelings that you might have in that situation. Our aim is to help you prepare for the scene in advance so that you get the payoffs of seeing your friends in the lunchroom, even if Rachel is sitting nearby with some of her friends. How does that sound to you? This setup places the goal and the strategy in the context of ABA and introduces the ratio­ nale as a workable alternative to techniques that would have poorer social validity or a higher chance of negative outcome. Behavioral skills training includes stating the intention for a skill that should be practiced, providing the rationale, modeling, rehearsal, and feedback. So far in the setup, the intention has been stated and the rationale given with an opportunity to ask questions for clarification. The following could be used as the remainder of the behavior skills training (BST) guided imagery session: I’d like to ask you if you’d be willing to close your eyes. If you’d prefer, you can begin with your eyes open and simply focus on one point on the floor in front of you. Sit up straight in your chair, and let your arms come to rest on your lap. At this time, I’d like you to notice any sounds that you can hear coming from outside this room. Notice any sounds that you can hear inside this room now, other than my voice. Now I’d like you to imagine that you can hear the sounds of the lunchroom from outside that room, as though you were in the hallway. Can you hear the sounds of people eating at the food counter? And at the tables? I’m doing this too. I can hear the sound of Mr. Bolton’s voice, ushering kids in. I can hear a lot of laughter and all kinds of metal banging behind the lunch counter area. What do you hear? Now you can open your eyes and look around the room here for a moment. You’re not in the lunchroom, but you and I did hear things there, right? Did you notice your­ self smelling the lunchroom area? I did too! If you’re willing, go ahead and close your eyes again. This time we are going to walk inside the lunchroom and go stand in line for food. Now you can hear the con­ versation of the kids in front of you. You know them. They’re in your homeroom class. What are some names of kids in your homeroom whose voices you might hear? Go ahead and listen to see if you can hear their voices and some of the things they might be talking about as they wait to pick up their food. You can open your eyes again for a moment. Who did you hear? What were they talking about?

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Let’s try this again. This time you are going inside and there’s just a few people in line, so you move right through the counter, pick up your food, turn, and begin scan­ ning the room for your friends. Before you see them, you notice that your heart rate is spiking and you’re sweating. It’s pretty uncomfortable. You are worrying that Rachel will see you and whisper to her friends about you. That could happen. You don’t see her. You’re wondering if she’s even there. Open your eyes for a moment if you will. What did you notice about the sensations in your body just now? Your heart started beating faster, didn’t it? That’s normal. The ways that we talk to ourselves can produce the same sensations that seeing other people and hearing other sounds can. Isn’t that interesting? Let’s try this one more time. This time you are now turning toward the lunch tables, and you hear familiar voices at a table on the other side of the room. The voices are those of your friends. They’re goofing around, eating, and showing each other things on their phones. What sensations do you notice now? If you noticed that you were excited about sitting down with your friends, that’s great. If you were nervous and thinking about Rachel, that’s normal and not even bad. It is good to notice these things and not get surprised by your reactions to them. Now imagine that you are moving your feet and you can feel your sneakers slightly squeaking against the floor as you walk toward your friends. As you come closer, you hear the conversation they are having. You’re getting comfortable with all of this, right? But now, as you get closer to the table, you notice that at the table behind your friends is a group of girls. Their laughter catches your attention. Now what sensations do you observe? Are your hands trembling? Mine kind of are, because I can relate to how this must feel like to you. You move closer to your friends’ table and you can hear the familiar lilt of Rachel’s voice. She’s at the table of girls behind your crew of friends. You can feel your heart begin to race, and you are sweating a bit more than before. Open your eyes for a moment and notice that you are here, and even though you are here, a lot of thoughts and emotions came up. What were your thoughts? What were your emotions? If you had the thought that it would be best to go somewhere else, then you are just like me. That’s what I was thinking. It sure would feel safer to just pack up and leave the lunchroom. The trouble is, all your friends are here and if you left right now, you wouldn’t get to share your lunch with them. And there’s more. Rachel is going to be in the hallway later, in class after that, and probably even in the playground during afternoon recess. It’s scary right now. But you’ve got a choice. You could take a seat with your friends, but on the other side of the table, so you don’t have to make eye contact with Rachel. You could go and sit down for five minutes today, and then leave. Tomorrow, maybe

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you could set a goal for sitting with your friends for ten minutes. The day after, you might even try not paying close attention to where you sit in relation to Rachel. She’ll just be where she is. It’s going to be scary for a few days. You can feel it right now. And there’s some­ thing exciting about this, too. You’re learning how to bounce back after a setback. You’re learning how to hold your head high and walk with a cautious assuredness, even when you don’t feel too sure at all. It’s scary. And it’s cool. My buddy and his kid came up against something really similar. They called this business of getting back out there “scary-cool.” The procedure in this exercise involved the same kind of progressive experiences that might be done in a guided exposure exercise, except this was verbal exposure. At its core, ACT is almost always verbal exposure, in which the operant principle at play is extinction. Here, we are progressively extinguishing the aversive functions of seeing Rachel and adding new func­ tions of excitement at spending time with friends when Rachel is nearby. The procedure was contextualized in advance so that Arif didn’t think it was weird, and a plan was initiated for progressively increasing the level of exposure that Arif would have in the lunchroom over the course of several days. Following the guided imagery, the therapist would use contingency con­ tracting and recommend a self-monitoring data collection system so that Arif could set his own goals and track his progress. Together with his therapist, the two could decide whether any other reinforcers are needed to maintain this behavior. However, it is possible and preferable that the natural reinforcers for sitting with his friends and getting back into the swing of things would be sufficient enough.

Core Competency Practice Developing competence in ACT requires skills practice in multiple component repertoires. This volume makes use of a breakdown of ACT component skills first introduced by Luoma, Hayes, and Walser (2017) but modified for BCBAs. In this section, a brief description of a clini­ cal situation is followed by dialogue that ends with a client statement. After that are questions that offer you practice at writing out fitting responses that reflect the competency and ratio­ nales for your answers. It is possible to take the dialogue in many ACT directions. However, in these exercises, maintain a focus on the repertoire at hand (in the current chapter: willingness) in order to build skills sequentially toward the broader aim of developing precise interventions. Later, you will want to create exercises that target synthesized contingencies. At the end of the chapter, look for the model responses and compare them to your responses. Note that there are limitless numbers of ways to approach these issues; no one way is right or best. The first exercise is an example of how to complete this task.

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EXAMPLE: COMPETENCY 3: The BCBA actively uses the concept of workability in applied interventions. CLINICAL SITUATION: The client is a twenty-five-year-old RBT taking classes toward a BCBA credential. She is avoiding practicum assignments that need to be performed with a client. She tells her supervisor that when she is given feedback by her professor on ways to improve, she feels stopped and unable to do anything. Supervisor:

I think I get it. Let me see if I can recreate what you said. You hear the words, “This is very good. Let’s see if we can sharpen up the edges a bit. Would you be willing to do this again a little differently?” and the words land on you like a ton of bricks. You feel like you’re being attacked—you can’t do anything right. So, you freeze, and you don’t try again so that you can avoid feeling attacked. Is that it?

RBT:

I figure if I just make myself really small, then my prof will lay off or forget.

1. Write what your response would be. Your emphasis should be on competency 3. Supervisor:

It’s completely understandable. I can recall times in my training when I felt that the feedback I was getting was an attack. But there’s a hook here. Your prof doesn’t forget, does she? In fact, she’s contingent in the same way that I am. In other words, making yourself small and avoiding the feeling of getting attacked isn’t working for you, is it?

RBT:

I guess. When I see her, she’s so nice and she doesn’t have to say anything, but I still feel like I’m being attacked.

2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. First, I’m aiming to validate the RBT’s experience and then to underscore that she wouldn’t be coming to me with this issue if her control strategy wasn’t functioning for her as she’d hoped. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 1: The BCBA communicates to clients that they are not broken but are using unworkable strategies. CLINICAL SITUATION: A BCBA is assisting a nine-year-old boy named Sam who avoids bedtime routines because he gets nightmares. Sam:

I just want the nightmares to go away. I get too scared.

BCBA:

And that’s why you run away when it’s time to brush your teeth and change into PJs.

Sam:

If I stay up long enough, then it’ll be time to go to school and I won’t have nightmares.

1. Write what your response would be. Your emphasis should be on competency 1. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

COMPETENCY 2: The BCBA helps clients make direct contact with the paradoxical effects of emotion control strategies. CLINICAL SITUATION: This dialogue continues where the dialogue for competency 1 left off but later in the session. BCBA:

Isn’t that strange, Sam? It’s so weird. You hang out in the loft so that you get out of going to bed, but then you fall asleep there and then not only do you have nightmares, but there’s no one there to help you. That must be awful.

Sam:

I hate the loft. I never wanna go there again.

1. Write what your response would be. Your emphasis should be on competency 2. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 3: The BCBA actively uses the concept of workability in applied interventions. CLINICAL SITUATION: This dialogue continues where the dialogue for competency 2 left off but later in the session. BCBA:

Are there other strategies that you’ve tried for getting rid of the nightmares?

Sam:

Oh yeah! Like keeping the flashlight on and talking to myself. One time I talked to myself until I didn’t have anything left to say and then I fell asleep.

BCBA:

How well did talking to yourself work?

Sam:

I didn’t have enough to talk about. I fell asleep. I don’t remember if I had nightmares, but when I woke up, I felt scared because I had been asleep.

1. Write what your response would be. Your emphasis should be on competency 3. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

COMPETENCY 4: The BCBA actively encourages the client to experiment with stopping the struggle for emotional control and suggests willingness as an alternative. CLINICAL SITUATION: This dialogue continues where the dialogue for competency 3 left off but later in the session. BCBA:

Sam, this has just been so hard for you. I feel so bad for you.

Sam:

Really?

BCBA:

Absolutely. And I think I can help. Let’s play a game.

Sam:

What kind of game?

1. Write what your response would be. Your emphasis should be on competency 4. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 5: The BCBA highlights the contrast between the workability of control and willingness strategies. CLINICAL SITUATION: Sam’s mother, Agnes, is a thirty-two-year-old bank teller who does very well learning and implementing natural environment and tabletop ABA interventions. She can manage her son’s extinction bursts during these exercises. But Sam waking up frightened triggers memories Agnes has of being alone at home with babysitters she didn’t know on nights that her own mother went out. She relives her own terror when Sam cries, worries that she is being a bad mom, and lets him climb into bed next to her. BCBA:

It’s almost as though Sam’s nightmares trigger yours, huh?

Agnes:

I honestly feel like I’m going to crawl outside my skin.

1. Write what your response would be. Your emphasis should be on competency 5. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

COMPETENCY 6: The BCBA helps the client investigate the relationship between willingness and suffering. CLINICAL SITUATION: This dialogue continues where the dialogue for competency 5 left off but later in the session. BCBA:

My guess is you’ve spent a lot of time managing your distress over having these memories when Sam cries.

Agnes:

Every night.

1. Write what your response would be. Your emphasis should be on competency 6. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 7: The BCBA helps the client make contact with the cost of unwillingness relative to valued life directions. CLINICAL SITUATION: This dialogue continues where the dialogue for competency 6 left off but later in the session. BCBA:

What do you think is the impact all this is having on Sam?

Agnes:

Well, he needs to sleep at least a few hours before he goes to school, so even if I don’t like it, I think this is the right thing for me to do.

1. Write what your response would be. Your emphasis should be on competency 7. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

COMPETENCY 8: The BCBA helps the client experience the qualities of willingness. CLINICAL SITUATION: This dialogue continues where the dialogue for competency 7 left off but later in the session. BCBA:

Can you imagine what it might be like if Sam learned to get back to sleep on his own after having a bad dream?

Agnes:

Yes, of course. But he’s not doing that right now and I don’t see how anything I do is going to help.

1. Write what your response would be. Your emphasis should be on competency 8. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 9: The BCBA uses exercises and metaphors to demonstrate willingness as an action in the presence of difficult internal experiences. CLINICAL SITUATION: This dialogue continues where the dialogue for competency 8 left off but later in the session. BCBA:

You mentioned that when you hear Sam crying you feel like you are going to crawl out of your own skin.

Agnes:

That’s exactly what it feels like, yes.

1. Write what your response would be. Your emphasis should be on competency 9. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

COMPETENCY 10: The BCBA models willingness in the therapeutic relationship and helps the client generalize these skills to other contexts. CLINICAL SITUATION: This dialogue continues where the dialogue for competency 9 left off but later in the session. Agnes:

I get why you’re asking me to do this. But in the end, if I have to choose between running a program and my son getting some sleep before school, I’ll probably go back to doing what I’ve been doing.

BCBA:

Sam’s well-being means the world to you.

Agnes:

It’s everything to me.

1. Write what your response would be. Your emphasis should be on competency 10. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 11: The BCBA can use a graded and structured approach to willingness assignments. CLINICAL SITUATION: This dialogue continues where the dialogue for competency 10 left off but later in the session. Agnes:

It seems like the only thing I need to change is everything.

BCBA:

That’s one way of putting it. But we can take it step by step.

Agnes:

What do you mean?

1. Write what your response would be. Your emphasis should be on competency 11. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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Core Competency Model Responses Additional model responses are available at http://www.newharbinger.com/45816. COMPETENCY 1: The BCBA communicates to clients that they are not broken but are using unworkable strategies. Model Response 1a BCBA:

It makes sense to me. You stay up until it’s time to go to school and there’s no chance of a nightmare.

Sam:

Yeah.

BCBA:

But then what happens the next day? I’ll bet you feel pretty cranky, huh?

Sam:

Uh-huh.

BCBA:

The thing is, you’re doing everything right, Sam. You’re doing what any kid in your situation would do—you’re trying to win this game. And you’re pretty skillful. I mean, you’re doing everything you can to win—you run when it’s time to brush your teeth, you hide out in the loft…There’s only one thing, though. Put your spyglass on with me for a minute. Let’s look closely at this. Do you see what I see? Nothing you do to make the nightmares go away seems to really work, does it?

Explanation: Sam’s behavior is under the control of a history of negative reinforcement for running away

when challenged. The issue here is that running away doesn’t serve the intended function and, at some point, he falls asleep. There is an additional problem, in that Sam’s mother allows him to spend the night with her when he screams, so screaming after awakening is positively reinforced. The BCBA in this situation aims to validate the effort Sam makes to solve his problem and to underscore the fact that any kid would want to do the same thing. We learn early in life to escape scary situations and to the extent that staying up is about that for Sam, the therapist is well to point out that this is what skillful people do.

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COMPETENCY 2: The BCBA helps clients make direct contact with the paradoxical effects of emotion control strategies. Model Response 2a BCBA:

Going up to the loft to escape is the perfect solution, isn’t it? And yet, it turns out to put you right in the clutches of the evil demons in your nightmares. I can imagine how confusing that must feel—the thing that should solve the problem ends up making it worse.

Sam:

If I brush my teeth, they’ll know I’m coming.

BCBA:

And if you hide in the loft and fall asleep there, what happens?

Explanation: It is unsettling to find that trying to solve the problem in the ways that other problems are

solved worsens this kind of problem. Here, the BCBA validates Sam’s effort, offers him empathy, but also places his efforts to rationalize the escape responses on extinction.

COMPETENCY 3: The BCBA actively uses the concept of workability in applied interventions. Model Response 3a BCBA:

I’ll bet running away works when kids are chasing you on the playground.

Sam:

I’m fast!

BCBA:

And yet, this doesn’t seem to be like that at all. You’re fast at running, but running from sleep isn’t like that. When you’re running away from sleep, do you ever get that feeling that you’re winning, or is it more like you feel like you’re cheating and you’re about to get caught?

Explanation: It’s important that the BCBA highlights the discrimination between situations in which Sam’s

skills work and those in which they falter. The BCBA is subtly pairing with Sam and setting the occasion for asking him to try some things that require a higher response cost.

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COMPETENCY 4: The BCBA actively encourages the client to experiment with stopping the struggle for emotional control and suggests willingness as an alternative. Model Response 4a BCBA:

What if your mom and you were to spook the spooks! The spooks in your dream just love it when you’re scared of them. But what would happen if you walked up to them and offered them a hot cup of milk? After all, you go to bed with a sippy cup of hot milk. How about you bring one for the spooks and instead of them coming after you, you go after them with kindness and friendship?

Sam:

They’ll laugh at me!

BCBA:

Of course, they will! That’s what spooks do! What do you imagine you could do next when they do? I mean, I don’t know what’s going to work to get them off your back, but by this time you’ve sure startled them. What could you do to keep confusing them like they used to do to you?

Explanation: Sam is being invited to playfully reverse his steps and do the opposite of what he has been

doing. The BCBA here doesn’t dispute that things are going to continue to be difficult. He is instead acknowledging that Sam might have to approach this with the same kind of upside-down logic that has been confounding him thus far.

COMPETENCY 5: The BCBA highlights the contrast between the workability of control and willingness strategies. Model Response 5a BCBA:

And here’s the thing. Allowing him to stay in your bed means neither of you sleeps well. And it gets worse from there, because Sam learns that screaming in the middle of the night gets him out of his room and into the comfort of your presence. It’s almost as if by letting your own demons push you around, you’re forfeiting everything you’ve worked for in learning to place unwanted behavior on extinction.

Explanation: Agnes has previously mastered blended instruction and using differential reinforcement to

treat her son’s daytime behavior. Nighttime behavior is proving to be challenging to her. Here, the BCBA underscores the disparity between what happens when she uses these skills and does not. But the BCBA also points out that the influence of her own private experiences might be the context in which she engages in experiential avoidance.

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COMPETENCY 6: The BCBA helps the client investigate the relationship between willingness and suffering. Model Response 6a BCBA:

In ABA sessions during the day, I watch you. You get upset sometimes. It’s pretty natural; I do too when Sam pinches me the way he does. I’m wondering, what do you think would happen if you quit putting all that effort into warding off the upset you feel at Sam’s crying? It seems like this struggle is what’s producing a lot of pain and anguish. What do you think might open up if you were to drop the struggle with feeling bad about Sam screaming?

Explanation: At this stage, ACT involves some detective work. Sleuthing out the control agenda and juxta-

posing it to a healthy acceptance of some measure of pain bears out the difference between pain that is unnecessary and pain that is part of growth and development.

COMPETENCY 7: The BCBA helps the client make contact with the cost of unwillingness relative to valued life directions. Model Response 7a BCBA:

I get it; Sam’s sleep is that important to you. Certainly, it seems like giving up your sleep is a sacrifice you’re willing to make in service of your value of being a good mom.

Agnes:

You don’t see it that way?

BCBA:

Well, let’s play this out. My aim is to help you arrange the environment to make sure that Sam is successful in school and in life. The question is, what price do you want to pay for peace? Would you rather have a few nights of screaming now to get it over with, or several weeks of screaming later, after Sam has learned that in the end, you give in?

Explanation: The cost of a delayed reinforcer is juxtaposed here against the cost of discounting its worth

and cashing in for a smaller reinforcer that is immediately available. Note that the BCBA is also subtly challenging Agnes’s rationalization that this is a values-based move on her part. The BCBA delicately suggests instead that allowing Sam to come to her bedroom serves an avoidance function for her.

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COMPETENCY 8: The BCBA helps the client experience the qualities of willingness. Model Response 8a BCBA:

You’re spot on here—he isn’t getting back to sleep on his own right now and his bad dreams seem to have a life of their own—they keep coming back, and surely you can’t control that.

Agnes:

So, you’re agreeing with me?

BCBA:

I sure do see where you’re coming from. In fact, you’re making my point exactly. Everything you’ve been doing has been in the spirit of trying to control how Sam sleeps and how it makes you feel. Nothing has worked out that way, though. Your ability to control Sam’s experience and your own internal reactions to his screaming ends in both of you getting fewer and fewer hours of sleep each night. This led to Sam’s grades falling and complaints from his teacher about verbal aggression with peers at school. I want to suggest that there could be an alternative here. The alternative is something we haven’t discussed much yet and it’s a bit counterintuitive. What if you were to model for Sam what it is to be okay with feeling uncomfortable? It’s something you want—you want for Sam to learn to become comfortable with feeling uncomfortable with things that are challenging. We went through that when he learned to mand and tact using vocal language a few years back. Maybe this is like that. Except you, too, have an opportunity to climb the same mountain, right beside Sam, getting comfortable with feeling uncomfortable. No reason you can’t share that with him and let him know you’re learning this at the same time he is. You’re right there with him, except in the next room.

Explanation: The BCBA in this segment sides with Agnes in observing that the control agenda has failed

her and, instead, invites her to try willingness. Importantly, this invitation is to Agnes in service of her value of being the best mother she can be. In that vein, she is being asked to model the behavior she wants her son to try.

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COMPETENCY 9: The BCBA uses exercises and metaphors to demonstrate willingness as an action in the presence of difficult internal experiences. Model Response 9a BCBA:

I’d like you to try something with Sam. I’d like you peel a mango in front of him and tell him to take a bite of this delicious, nutritious fruit. Then I’d like you to tell him that this is what it’s like for you. Hearing him scream feels like you are going to crawl out of your own skin, just like the mango. But then ask him to notice what’s available now that you allowed yourself to feel that. The fruits of this difficult task are there for you both to enjoy.

Explanation: Agnes’s metaphor serves as a launchpad for an exercise that she can do with her son.

Physicalizing the metaphorical with Sam is likely to be beneficial for both of them in that Agnes will learn about willingness in teaching it.

COMPETENCY 10: The BCBA models willingness in the therapeutic relationship and helps the client generalize these skills to other contexts. Model Response 10a BCBA:

And you know, Agnes, your well-being means that much to me too, as does Sam’s. Because I care about how you feel, I’m noticing the pull to just let this go and not press you anymore on this. I feel the pushback in your tone of voice and part of me wants to just back off. And yet, I’m asking myself, what would that be in service of? I’d be off the hook. But if the goal is changing Sam’s behavior, would it be more fitting for me to model leaning in and challenging you when you push back?

Agnes:

I think I see what you mean.

BCBA:

And then the next question is, what about you with Sam?

Explanation: When clients push back, it is often because they sense that the BCBA is asking them to do

something that they cannot or will not do themselves. BCBAs use modeling not only to show how a skill is done, but also to demonstrate that they will perform the operation themselves even if it is difficult, that they might even make mistakes, try again, and after a few tries, get it right. Modeling the willingness to be present with difficult bodily sensations, emotions, memories, and thoughts is important when a client is pushing back in order to demonstrate doing things that are hard.

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COMPETENCY 11: The BCBA can use a graded and structured approach to willingness assignments. Model Response 11a BCBA:

Well, let’s try a few different things. First, I’m wondering if you’d be willing to self-monitor the duration of time you let Sam scream before inviting him into your room. Write this down three nights in a row. If the average is, say, three minutes, how about you set a goal to let him be for five minutes. Do that a few nights and then, if you’re willing, extend the wait time to eight minutes.

Explanation: This is a changing criterion design approach that incorporates the measuring of a baseline

duration and a few next steps. The steps are clear and straightforward. This is a context intervention and might be best used in connection with a process intervention, detailed below. Model Response 11b BCBA:

Now along with that, I want to see if you might try an additional exercise. As you’re letting Sam scream, you are going to be noticing memories of being left alone at home and thoughts of Sam getting in trouble in school for being sleepy or aggressive. Would you be willing to imagine, during these moments, that this is the peeling of the mango’s outer skin? It is slow, deliberate, and challenging. Imagine that you’re waiting until the skin is completely removed before tasting the fruit within.

Explanation: The process intervention is important because indirect-acting verbal barriers could undermine

the direct contingency management strategy described in 11a. When verbal interference is not a problem, there may be no need for a process intervention. But in this case, Agnes’s verbal behavior and private experiences are such that they are likely to impede effective action unless they are addressed with an intervention targeting willingness.

CHAPTER 9

Defusion

Writing a chapter about defusion is tricky business. It absolutely must be perfect. In a nutshell, that’s what living under the control of unworkable rules is about. It’s a little like telling yourself you’ve got to get up when the alarm goes off at 7 a.m., but after mistakenly setting the alarm to go off at 1 a.m., instead of rolling back into the pillow, you rise and dress for work. The rule, “get up when the alarm goes off,” is a good directive to follow, but not in this circumstance. This example illustrates cognitive fusion—relating events in a particular manner without considering the context. When two events are related in a particular way, the context in which the relation inheres may be either stated or implied. The same is true for the consequences of acting in accordance with the relation. Relating a plant-based diet as better than a meat-based food regime may be connected to consequences for the planet or for your health. In either case, the implied consequence that informs the relation of one being better than the other makes it function as a rule, and it may well be a good rule to follow. However, when traveling to conduct behavior analytic work in certain regions of the world, it may be very difficult to locate vegetables that are safe to consume. If you are on a prolonged trip for several months and you cannot bring adequate quantities of plant-based nutrition with you, eating meat for a period may be the only way to get enough protein into your system to ward off other health problems. And if you are there to provide behavioral or psychosocial ser­ vices to others, becoming weak or coming down with an illness would decrease the time you have available for offering vital services to others. Attending to this context gives you the cog­ nitive flexibility with which to decide to change the rule for a brief period. Of course, some rules are easier to shift in context than others. In the previous example, a person who has been vegan for just under a year may be able to change their diet for a few months quite easily. But imagine what this situation would entail for another person who has been vegan for decades and made this dietary decision after carefully weighing the ethics of meat consumption. You can imagine that with this person, a complex network of intercon­ nected rules, such as “meat means murder,” “peace starts on our plates,” “my plate is green; your plate is blood red,” and “my body is not a graveyard,” would make the decision to temporarily eat meat untenable, even given the context of extended travel in a region with limited options. Consider another example closer to home. You supervise Alice, a BCBA who learned during her training to use “planned ignoring” when the treatment goal is to reduce attentionmaintained behavior. Alice is skilled at writing a variety of differential reinforcement programs

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(DRA, DRL, DRH, DRI, DRO) for treating behavior functionally related to social positive consequences. In her graduate school and practicum training, instructors taught that differential rein­ forcement is fastest and therefore best when applied with an extinction component. However, Alice is now working with a client whose family has made it clear they do not want attention extinction used with their child. She tries to persuade the family, but they view extinction to be aversive and therefore unacceptable. Alice is at a loss. She does not know how to proceed. She has read about differential reinforcement options that involve high- versus low-reinforcer density (i.e., applying the matching law within a differential reinforcement strategy), but in graduate school she learned that these tactics may require more time to take effect. She com­ plains to you that the family is refusing optimal treatment and she would prefer working with another family. The matter is complicated, because this is not the first time that Alice has asked to be removed from a case rather than adjusting the intervention to suit a family’s needs or preferences. Alice tells you that it is not in the child’s best interest to make treatment deci­ sions based on others’ preconceived notions. In the end, Alice’s rigidly held rules are presenting challenges for your agency, and you are faced with the difficult task of determining how to help her learn to hold these rules more flexibly. It would be great if you could simply explain the matter to Alice logically. But the difficulty with problems like these is that behavior under excessive verbal regulation does not respond to logic because the verbal system that regulates behavior is itself impeccably logical. After all, Alice is correct; differential reinforcement using alternatives to extinction can in some instances require more time. You might be moved to overpower her logic by arguing that these alternatives show less resurgence and are therefore potentially more beneficial. But even the best of logical reasoning is likely to fail with Alice due to the way verbal relations that cohere together form impenetra­ ble bonds. As in the previous example, making progress with Alice will be difficult if she has a vast network of related rules that cohere, such as “I have to get results quickly,” “behavior ana­ lysts are the experts,” “families need to follow BCBA recommendations,” and “insurance won’t pay for inefficient treatments.” Each verbal relation strengthens the next, and the cumulative effect is like mortar cementing the bricks in a wall. A good mason drills holes in the mortar to remove bricks one by one from a densely con­ structed wall. Traditional cognitive behavior therapy does this with cognitive reappraisal—by teaching clients to question whether a rule is true or not in various situations. But some verbal networks, or networks of networks, are so densely compacted over a life­ time of relational learning that locating individual associations and drilling through the verbal mortar would be futile. In a vast verbal system, there are just too many implicit relations that fit together to effect behavior change by removing any cluster of the “bricks.” In other words, it may be good to try and help a person like Alice by challenging them to test whether their rules apply in a particular context. But if this doesn’t work, recognize that fusion is at play. Fusion is behavior under the tight control of a network of unworkable rules applied irrespective of context and consequence.

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Defusion strategies loosen the mortar of these relations by altering the global context in which they are applied. Defusion is effective when literal, language-based strategies for under­ mining rules are not because it operates on the verbal system as a whole, rather than on indi­ vidual relations. You might say that defusion works by temporarily shutting off language so that behavior can come under the sway of more direct sources of control, thus increased learning can occur. As a brief example, consider trying to logically persuade Alice of the folly in her system of rules in a carefully reasoned argument, point by point. Alternately, consider asking her to write the rules described earlier on a sheet of paper, pointing to and holding them in place on the wall with her index finger, and then joining a meeting of people seated at the other end of the room. Your logical argument is likely to evoke a counterargument from Alice, but providing her a direct experience of tightly clutching a set of rules may result in an experience outside the usual confines of language. The exercise could even elicit a chuckle and Alice’s recognition that demanding others follow her rules is likely to backfire.

The Importance of Defusion Humans can learn about the world through direct experience, much as any other organism. But learning by contact with direct contingencies is slow and potentially aversive. You could acquire very bad habits as a BCBA in the time it takes to learn from experience that developing treat­ ment with the team of mediators is better than demanding everyone agrees to what you devel­ oped alone in your office. These bad habits may result in someone complaining or withdrawing from services. You could lose your job over such practices. Fortunately, humans can also learn verbally. This saves time and reduces exposure to aversive contingencies. For this reason, train­ ing in which you are given rules to follow is an important part of human learning. In fact, humans with the acquired capacity for verbal learning are at a distinct evolutionary advantage over those without such skills. We can learn from instruction to avoid ethical mis­ conduct that would likely result in expulsion from the group. We can learn procedures that transform days of effortful experience into minutes by merely memorizing the steps in a written task analysis. We can design algorithms that clarify otherwise fuzzy decisions to be made. So, what distinguishes healthy rules from the kind of inflexible ones that Alice invokes? Technically, stimuli that specify contingencies and alter the functions of psychological events acquire strong control due to their direct eliciting and evocative functions and indirect partici­ pation in networks of relations with similar properties. What this means is that when we repeat rules to ourselves, we feel their urgency and immediately act to satisfy the contingency. This can be beneficial when haste is needed, but it can also be detrimental in contexts where caution is required, or when the application of the rule needs to be scaled. When intense emotions are elicited alongside a history of reinforcement and punishment in similar situations, derived rela­ tional responding becomes automatic. In these situations, it is easy to follow the rule with little or no attention to important situational nuances.

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In lay terms, you might say that problems with rules emerge when they are mistaken for true representations of the world they describe. I was once using the Maps smartphone app to guide me on my drive to a conference a few hours from home. I drove by night and there was a crew performing maintenance on a section of the highway for which they detoured all drivers onto the smaller back roads. After I followed the detour, Maps reconfigured and led me to the next highway on-ramp, from which I was instantly pushed back to the frontage road. It was three times back and forth before I realized that the stretch of road this crew was repairing was long, and Maps was only programmed to guide me back to the unavailable highway route. By repeatedly returning to the highway, I was mistaking my map for an accurate representation of the world. I needed to relinquish the map and begin navigating by compass and street signs. Defusion is the capacity to set aside unworkable maps of the world that others have drawn for us or that we have drawn for ourselves based on past experiences. But defusion can serve a much larger purpose, too. Behavior analysts, supervisees, parents, and children suffer from language traps that emerge from the juxtaposition of combined verbal relations that evoke avoidance. For example, imagine that Honoré has learned “making mistakes is bad.” One day, after missing several points on a school test, she tells herself, “I made a mistake.” The very natural relation that Honoré will derive almost automatically is, “I did something bad.” Within the all-too-common home or school contexts of being punished for doing bad things and avoiding punishment by concealing undesirable actions, Honoré is likely to hide her mistakes. Concealing small learning errors in school activities results in missed opportunities for getting help that will advance her skills and put her in contact with larger reinforcers. Thus, defusion work has a larger aim of shifting the contexts in which derived relational responding with unwanted effects occurs. In lay terms, defusion is a useful tool for helping others unglue themselves from sticky labels, thoughts, and memories. It is an important skill because it undermines the automatic way that language serves to mortar thoughts together and produce contexts for ineffective action.

Functional Assessment of Defusion Deficits Fusion can be noted in statements a client makes that reflect an impermeable seal between thoughts and emotions or actions. Characteristic tells or phrases include the words “should,” “ought to,” “have to,” “can’t,” “supposed to,” and “expectation.” These words indicate the likely presence of a rule that prescribes action in the presence of particular emotions or events. For example, a person telling you, “This is stupid; I’m supposed to be able to accomplish the tasks you give me,” is indicating their bond with the rule that when given a task they are to complete it. There is nothing inherently wrong with this thought, but it could be a problem if the speaker is unable to see the situation from any other angle or unable to recognize the difference between the current situation and others in which they have been able to act as directed. Beyond words that can tip you off that a person could benefit from defusion work, there are telltale qualities of spoken language that you might listen for. Because we talk about thoughts

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and emotions that occur in connection with events, it is natural that those untrained in behav­ ior analysis conclude their thinking is true and their emotions are causal. Aspects of these thoughts and emotions might be things that a person you work with tells you about, but other aspects can be listened for in their speech cadence, tone, and pitch. Fused speech is often tied to a story that has been told over and over again, so there is often a monotone quality that you can hear. Whereas defused speech may ring with changes in cadence and pitch, the delivery of fused speech can often be tired and soft. Imagine that the rules for living have been beaten into the person you’re working with so much that when they talk about it, their exhaustion is audible. Accompanying this may be a downcast demeanor, sunken shoulders, or aversive eye contact. But an entirely different set of auditory reads and visual cues may characterize fusion. Fused speech can be vibrant, loud, and strongly worded. A speaker fused with emotion may describe action they have taken or are planning with animated energy. Fused, emotion-laden speech can be evocative of action—sometimes powerful, aggressive action. There is something about energetic fused speech that distinguishes it from the same kind of vigor and action present in the speech of someone defused and highly excited by what they are talking about. Energetically fused speech is quarrelsome. It lacks a willingness to entertain the possibility of being slightly wrong or off the mark. Because of that, you might notice that the speaker is agitated. In fact, a critical thing to observe or look for is whether the speaker is dis­ tressed by what they are describing. Defusion is not a lack of conviction, and conviction is not fusion. Fusion is distress that accompanies a wholesale belief about something for which the remedy is a single, narrowed course of action. The constricted quality of lived experience and its relation to behavior is what most poignantly distinguishes fusion. Additionally, you might assess fusion when someone seems to be trying to convince them­ selves or others of things they do not know from either experience or data. A speaker fused with their excitement may be compelling. They may be charismatic. They might be capable of leading vast colonies of people with their rhetoric. But a key element that separates fused lead­ ership from that which inspires careful, caring, committed action is that in fusion there is often a sense of discordance with others or certain groups of others. The opposite of fusion in this sense is what the Greeks called agape, an abiding love of all that walk the earth. You can be troubled by your neighbor’s behavior enough to let them know and take action to protect your­ self and others, but within that you may still love your neighbor and suspend the urge to blame them. In this, your energetic efforts to alter the conditions under which they do things that are harmful are characterized by defusion and values.

The General Approach to Treating Problems with Fusion As previously noted, fused speech is impervious to new information, so it makes little sense to try and expel older, well-established verbal relations by introducing new ones. Instead, the

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general approach in treating fusion is to undermine the entire network as a whole. Exposing the client to opportunities in which to experience the unworkability of the broad network of rela­ tions leads to a kind of verbal extinction that is followed by an extinction burst and then response variability. It is this variation in responding that a skilled therapist looks for and reinforces. One way to facilitate its emergence is by using the ACT matrix. Of the many methods for using the ACT matrix in treatment, one of the most powerful is to juxtapose interfering private behavior with productive overt conduct. This juxtaposition can be diagrammed in session and later, suggested as a home practice and data collection strategy.

Using the ACT Matrix to Promote Defusion In the example that follows, Caleb is an RBT who vigorously defends berating colleagues in the clinic who fail to return common materials after their sessions to the bins where these items are stored. Caleb is right that the policy is to return materials promptly after use. But colleagues have noted that his manner is demanding and hurtful. Note that in this example, because Caleb is already familiar with the matrix, the BCBA, Mo, does not pull out the matrix grid, but merely references it. This is one of the advantages of repeated matrix use—you may reference it without physically using paper, a whiteboard, or a computer. Mo:

Caleb, I was in the kitchen and overheard the interaction that you had with the other RBTs about returning materials to their bins.

Caleb:

I know; it’s like we’re in a war-torn nation here with everyone grabbing what they need for themselves.

Mo:

It feels like that to you, huh? Like being in a war zone.

Caleb:

Totally. I like working here and all. But it’s harder when people don’t do what they’re supposed to.

Mo:

For sure. We have rules in place for a reason.

Caleb:

Mo, do you think you could talk to them about this?

Mo:

I can see why you’d want me to.

Caleb:

It’s just they know it makes me angry and they hoard supplies anyway. They cache the games and markers, I can’t find them, the kid I’m working with has to wait while I hunt them down, and then my kiddo has meltdowns because I’m not attending to him, and of course, I get blamed.

Mo:

It’s a bad cycle of events, huh?

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Caleb:

Like dominoes, every time.

Mo:

Then you get angry and scold them.

Caleb:

It’s not scolding if the rule is clear and they’re not doing what we’ve all agreed to do. I’m just pointing up the contingencies.

Mo:

To you, it’s pointing up the contingencies. Do you think that’s how it lands for the other associates?

Caleb:

What does it matter how it lands? Somebody has to remind them. Their actions have consequences, too.

Mo:

I think I get it. It’s cause and effect. They do what they do, you feel angry, and you have to remind them.

Caleb:

It’s just that it happens so frequently that I’ve had enough.

Mo:

I’m pretty sure I’d be having the same reaction, especially if the kids I work with had meltdowns while I was hunting down materials for them and I got blamed. The thing is, I don’t really know how frequently this happens. I happened to be in the kitchen just now, so I heard you talking about it and I’ve heard from you and from the others that this kind of thing is not uncommon. But maybe you can help me out with this by keeping a record of days and times that you notice yourself getting hot under the collar and pointing up the contingencies to the other associates. Can you do that for a few days?

Caleb:

You want a paper trail.

Mo:

Would that be feasible? I want to get a pulse on this before I say anything more.

Mo is taking this slowly. They want to make certain that Caleb is tracking his pattern of private and overt behavior in the context of their workplace dilemma. It’s interesting to note that Mo is not taking sides and does not get hooked by the content of Caleb’s complaints. Instead, they orient Caleb to a discovery of the function his behavior serves. Watch now what happens as they come back to this discussion, several days later.

Building Exercises to Facilitate Defusion The next two dialogues involve Mo asking questions to evoke a metaphor and then physicaliz­ ing the metaphor Caleb uses to bear out the unworkability of his current behavior in this set of circumstances.

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Using Metaphors to Engage Others with Fusion The following exchange between Mo and Caleb occurs later in the week. Caleb:

So, I did what you asked. I definitely noticed there are no times anymore where I’m getting angry and not saying anything. But I think that’s good, as long as I don’t yell. I’ve never yelled at anyone.

Mo:

I haven’t heard you yelling either. You seem calm and even a little comical when you let people know they’re not following the rules.

Caleb:

I know, I can be a bit sarcastic about it. I used a matrix to write down what I’ve been saying, and well, I can be a bit sharp.

Mo:

Do you think maybe that could be something to examine? I’m asking because— check this out. Look at the frequency of these occurrences on your matrix grid. Do you see what I see?

Caleb:

Their hoarding supplies is increasing, not decreasing.

Mo:

And you getting hot under the collar about it is increasing. You making comments about it, that’s increasing.

Caleb:

You think I’m making things worse.

Mo:

I wouldn’t say that. I’d say what you said the last time we talked about this. You said it was like dominoes.

Caleb:

I remember that.

Mo:

Well, maybe it is. What can you tell me about dominoes?

Caleb:

They all fall down.

Mo:

They all fall down when you line them up a particular way.

Caleb:

You’re saying I cause them to forget they’re supposed to put things back in the bins?

Mo:

Hmm. When does a domino trip another domino?

Caleb:

When the one getting tripped is standing in the way.

Mo:

You’re the one getting tripped up, man.

Caleb:

So, I’m getting tripped up because I’m in the way?

Mo:

Because you’re standing in the fall line. What if you were to move out of the way?

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Caleb:

How would I do that?

Mo:

I don’t know. But isn’t it interesting that getting angry and pointing up the contingencies hasn’t been working the way you’d think?

Caleb:

So, you want me to figure out a way to move out from under the fall line. Interesting.

Physicalized Metaphor Mo has now set the stage for a little dramatic rendering that could be helpful. In the follow­ ing exchange, Mo uses books to illustrate the way defusion could be useful to Caleb. Mo:

Well, let’s see what that might look like. I’ve got books here in my office. Let’s line them up on their spines so that if one falls, it trips the others like dominoes. This one here, this red book is you, Caleb. You’re pretty much set to be nailed by the books coming down in front of you. If this red book is you, what can you do to keep from getting nailed?

Caleb:

Step out of the way, obviously.

Mo:

And now, I’m sure that if you could, you would step out of the way by grabbing all the materials you need at the beginning of the day. But that wouldn’t be right…

Caleb:

…Because there’s only one Spot It game and only one set of oil-based crayons. If I took what I thought I’d need, others would be left in the boat that I’m finding myself in.

Mo:

So, that kind of “stepping out of the way” isn’t an option. What else is there to do that would effectively get you out from under this domino fall line?

Caleb:

The thing I noticed in the matrix is that every time I get upset, I say something about it immediately, and you can tell I’m not pleased even if I’m smiling.

Mo:

An interesting observation. I’m with you. What of it?

Caleb:

I don’t know. I might be right, but even if I am, pointing it out to other people isn’t working for me.

Mo:

That’s an excellent point. Let’s say that pausing when agitated is akin to stepping out of the fall line. But is stuffing it and going without items you need in your session workable for you?

Caleb:

Not even a little.

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Mo:

Well, then, what’s there to do that you haven’t tried yet?

Caleb:

[Pauses] We have “stand up” meeting every morning when we come in. If I bring this up as a request in the morning meeting, do you think I’d get any traction?

Mo:

A request rather than a demand has a lot more power. I think you’re on the right track.

Caleb:

Will you back me up when I ask?

Mo:

I will. I can’t guarantee that this will lead to an immediate change in behavior. The rule and the agreement you’ve all made are one thing, but the contingencies seem to favor putting things away at the end of the day.

Caleb:

Can you offer some kind of reinforcers to RBTs for replacing items after each session?

Mo:

I can. And maybe we can try scheduling who’ll need which materials at what points throughout the day, so you’ll know where to look when something isn’t in the bins. But the best part is that you thought about tabling the sarcastic demands and replacing them with requests. We can’t say for sure, but I think our plan is a good starting point, Caleb.

One of the most important features to notice in the way that Mo handles the interaction above is that they partner with Caleb. Mo doesn’t lord over Caleb as an expert with a plan. They also don’t make Caleb do all the work on his own. Their partnership is evident throughout the exercise. Mo is clearly not a beginner at ACT work or supervising RBTs, but they don’t portray a need to be right, to know what would and would not work, or to be in control. This is impor­ tant, because those are qualities of fusion to which Mo is aiming to model an alternative. Instead, Mo models curiosity and a willingness to experiment.

Core Competency Practice As in the previous chapter, this section contains a brief description of a clinical situation fol­ lowed by dialogue that ends with a client statement. After that are questions that offer you practice at writing out fitting responses that reflect the competency and rationales for your answers. In these exercises, maintain a focus on the repertoire at hand (in the current chapter: defusion) in order to build skills sequentially. At the end of the chapter, look for the model responses and compare them to your responses. There are limitless ways to approach these issues; no one way is right or best.

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COMPETENCY 12: The BCBA identifies the client’s emotional, cognitive, behavioral, or physical barriers. CLINICAL SITUATION: A BCBA is aiding Liv, who had engaged in a tantrum for several minutes. The child has now been calm for over sixty seconds and the BCBA sits down on the floor beside her. Liv:

No one understands. I have to go first when we play. It’s only fun when I go first, and everyone watches.

BCBA:

You have so much fun when people watch you going first, don’t you?

Liv:

Yes! That’s what I keep telling them.

BCBA:

They have to let you go first, because that’s what makes playing this game fun for you.

Liv:

They should let me go first because it’s no fun for anyone if they don’t see how it’s supposed to be done. I’m the only one who can show them.

1. Write what your response would be. Your emphasis should be on competency 12. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 13: The BCBA suggests that attachment to the literal meaning of these experiences makes getting unstuck difficult and slow. CLINICAL SITUATION: The dialogue continues where the dialogue for competency 12 left off. BCBA:

Yeah. You say to yourself, “I’m the only one who can show them, so they should let me go first.”

Liv:

I tell them, too.

BCBA:

Yes, you do. And sometimes they like your idea but other times they want to go first. I wonder if maybe you could be thinking to yourself, “They should let me show them” and still go with the decision that the teacher makes?

Liv:

The reason I can’t do that is that then everyone would get it wrong and we’d have to do it all over again.

1. Write what your response would be. Your emphasis should be on competency 13. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 14: The BCBA juxtaposes the client’s verbal statements about the way things ought to work with their experience of what does and does not work. CLINICAL SITUATION: The dialogue continues where the dialogue for competency 13 left off. BCBA:

That’s a very interesting reason for making everyone let you go first. You figure, “They have to let me go first or they will get it wrong, and we’ll have to do it all over again.” You know, I’m a lot like you, Liv. Sometimes I get upset and, wow, do I have a lot of reasons for why I get upset.

Liv:

You mean no one will listen to you either?

BCBA:

Well, sometimes I notice that my reasons for making people do what I want are like commercials on TV. You see the commercials, but you don’t have to buy what they’re selling. My mind is telling me everyone should do what I want, but no one is buying what my mind is selling. And then I wonder, maybe I don’t have to buy it either, and then we do what they want to do. Do you think maybe you could do what others want to do even when your mind tells you that they should do what you want?

Liv:

Why would I do that? If they go first, it’ll be boring because they won’t get it right.

1. Write what your response would be. Your emphasis should be on competency 14. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 15: The BCBA uses metaphors and experiential exercises to help the client uncouple from their rigid verbal evaluations. CLINICAL SITUATION: The dialogue continues where the dialogue for competency 14 left off. BCBA:

You may be right about that. It may take longer. Can we take a moment to play this out and see?

Liv:

What do you mean?

1. Write what your response would be. Your emphasis should be on competency 15. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

Core Competency Model Responses Additional model responses are available at http://www.newharbinger.com/45816. COMPETENCY 12: The BCBA identifies the client’s emotional, cognitive, behavioral, or physical barriers. Model Response 12a BCBA:

You’re very sensitive, Liv. I can see you’re thinking about this a lot. You’re thinking about what would be best for everyone, not just you. And that’s when you have the idea that they have to let you go first, to show them. Now I’m wondering, because you’re very sensitive, what do you notice your stomach feels like when you’re saying to yourself, “I have to go first”? [Liv answers.] Now what do you say to yourself when your stomach starts to feel that way? [Liv answers.]

Explanation: After strengthening the therapeutic alliance, here the BCBA asks Liv to explore her physiologi-

cal and verbal responses. In a kindly way, the BCBA is setting the occasion for defused observation. If Liv takes the bait, this will be very different than inviting her to give her reasons and evaluations. Liv is very young, but it is possible that these questions will begin evoking a series of observations about memories and the way her thoughts have pushed her around in the past. These are things that the BCBA might bring up now or flesh out with her over time.

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COMPETENCY 13: The BCBA suggests that attachment to the literal meaning of these experiences makes getting unstuck difficult and slow. Model Response 13a BCBA:

Something I’m noticing, Liv, is that when you say to yourself that they should let you show them and that they’ll get it wrong if you don’t show them first, you yell at everyone. Then your tutor says something. What does your tutor say?

Liv:

They tell me I can let other people go first or I can go play by myself.

BCBA:

When you go to the toy store, what’s something that costs a lot of money that you really want? [Liv answers.] Now, if you had enough money for that but nothing else, you would have a choice. You could buy the most expensive toy and have no money for anything else, or you could buy something less pricey and have money for other things you like.

Liv:

My mom always shows me how leaving some money for later is better.

BCBA:

It’s a bit like that. It’s like, by making others let you go first, you’ve been paying the price for a very expensive item at the store and that’s leaving yourself with no money for anything else.

Explanation: Even behavior that is reinforced comes at a cost. Defusion exercises that underscore the

costs of taking thoughts literally focus on the way overt behavior can change once a client deems the cost of taking their thoughts as accurate representations of the world too high. As illustrated in this example, even a young child can be offered a way to price out the relative costs of buying their own and considering others’ thoughts.

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COMPETENCY 14: The BCBA juxtaposes the client’s verbal statements about the way things ought to work with their experience of what does and does not work. Model Response 14a BCBA:

I’m hearing you loud and clear. Or at least, I’m hearing what your mind is telling you. It’ll be boring because they won’t get it right. And when you began yelling, your tutor told you that you could let others go first or you could go play by yourself. Sometimes you’ve done exactly that—you’ve gone to be by yourself. That’s what you did today. What was that like for you?

Liv:

It was boring when I went and sat by myself.

BCBA:

What about everyone else? Were they having fun?

Liv:

I guess so.

BCBA:

Isn’t that interesting, Liv? Your mind told you one thing, but your experience was different than what you thought.

Explanation: When working with young children, revealing the inconsistency between the rules they estab-

lish and their experience is facilitated by drawing on the immediate circumstances. The more rapidly following an encounter with consequences, the better for spotlighting these direct contingencies. With older learners, you can draw more from past situations. In either case, comparing the outcome conceptualized verbally with that which is experienced shifts the context and prepares for the transformation of fused thinking into a class of less desirable behavior.

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COMPETENCY 15: The BCBA uses metaphors and experiential exercises to help the client uncouple from their rigid verbal evaluations. Model Response 15a BCBA:

I have an idea. This might even be fun.

Liv:

Hmm?

BCBA:

Let’s play Television. You’re watching a Saturday morning cartoon and then there’s a break for a commercial. I’m the commercial. [Liv sits up at attention.] And now a word from our sponsor. “Are you bored when other kids go first in games and do it all wrong? Don’t you just want to go sit by yourself in the corner over there? You don’t have to play with anyone else. You can go be by yourself!”

Liv:

But that’s no fun either.

BCBA:

How do you know?

Liv:

Because I just did that.

BCBA:

But think about it. It’s boring, boring, boring, boring when they all try and do things you know how to do better. You can yell at them and make them let you go first.

Liv:

I can. I know I can. I can yell at them, but then I get in trouble. Maybe I can show them how I do it after they show me how they do it.

Explanation: The power of a good experiential exercise is in the way it pulls a learner out of their head

and into action. Oftentimes, behavior analysts appeal to logic to occasion changes in behavior. But that is forgetting what we all know—that behavior is a function of its consequences. Experiences like Liv’s in this example bring consequences to bear in the nonthreatening world of play and give her an opportunity to try out different ways of interacting with her thoughts. Play of this nature gives a learner the chance to contact both indirect and direct contingencies. This is a powerful stage on which to practice acting with defusion.

CHAPTER 10

Present Moment Awareness

Effective stimulus control can be narrow, such as the heightened focus of a trail runner observ­ ing each foot placement on jagged terrain. Alternatively, it can be broad, such as the attention that a first responder at a natural disaster pays to the array of dangers that continue to threaten everyone’s lives. Flexible attention to the now is a useful nontechnical way of talking about these two forms of stimulus control.

The Importance of Present Moment Awareness In the physical world, transferring stimulus control involves making one set of stimulus events more salient than another. Increasing the volume of the verbal discriminative stimulus “Get ready!” can aid in bringing a learner’s attention to the immediate task at hand. Alternatively, assisting a young child with autism to work for highly coveted trampoline time later rather than a moment of marginally interesting puzzle play now, a behavior analyst might walk the child to the trampoline and say, “Work for this!” Walking the child to the stimulus that is available only after some work is a way of making this delayed reinforcer more salient and improving the prob­ ability that the child will work for this event in the present moment rather than for puzzle play. In this way, the analyst begins to teach delayed gratification, an important skill that is correlated with important life outcomes down the road. The problem that the analyst is addressing is delay discounting, the propensity of all organisms to downgrade the value of reinforcers that require more effort and time to access (c.f., Madden, Begotka, Raiff, & Kastern, 2003). By transferring stimulus control to the larger, later reinforcer, the analyst improves the chances that the child will work more right now in order to gain more play time later and generate a pattern of such behavior in the future. Beyond the immediate physical dimensions of experience, temporal aspects of stimulus control bear relevance upon our long-term success or failure. A parent whose child threw a tantrum in a supermarket is so deeply affected by the insulting comment made by another shopper that he lets his child select multiple bags of candy the minute his child begins a tantrum in the market. He says to himself, “I don’t want to ever let that happen again,” and behaves in a way that stops the past from repeating itself in the present, but at a huge cost—his child has learned that throwing tantrums pays off. In technical terms, the rule “don’t let that happen

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again” acquired discriminative functions for punishment. Also, the rule seems to have acquired augmentative functions in that it immediately evoked an avoidance response and diminished the function of extinction, a procedure he’d been taught would be valuable in these situations. It is worth exploring other examples in which the past or future impacts unhealthily upon our functioning in ways that are outside the physical dimensions of the immediate environ­ ment. A behavior interventionist is given a new program to work with, but when she tries to read it, her thoughts drift to the BCBA exam that she is taking next week. Instead of learning the new program, she continues running other programs that she can implement without exert­ ing the effort to learn the new program. Under her breath, she mumbles, “I’d like to learn this program, but I’m too preoccupied with the exam to pay attention to it.” This worker’s behavior is under the control of an event that has yet to happen, and it is impeding her ability to function effectively in the present context. Of course, the ability to plan for the future and learn from the past is one of the things that makes human adaptation to the world rather unique. Being limited to acting in the present moment would not be advantageous. We would be unable to plan for graduate school or pull from our experiences in undergraduate rat labs if we were limited to focusing on the present moment. On the other hand, many people seem to be unable to get beyond events from their past or find themselves unable to focus on specific events in the present when other things going on in their environment compete for their attention. This is defective stimulus control, or what is termed in ACT as preoccupation with a conceptualized past or future. The unique contribution of verbal regulation to the maintenance and change of stimulus control deserves special attention. Were it not for verbal regulation, augmenting or diminishing stimulus control would be simply a matter of changing the physical magnitude or size of stimu­ lus events in the present environment. But as we have seen in earlier chapters, rules and rela­ tional framing create contexts in which conceptualized events that took place long ago or loom ahead in the distance come to dominate our experience and alter the salience of present events such that they fail to bring behavior under optimal stimulus control. It is these verbal contexts where ACT training can be of most use to behavior analysts seeking to help clients make changes with respect to focusing on the now. ACT training in this area is a matter of ongoing, repeated practice. Discrimination tasks, metaphors, and exercises help transfer stimulus control in the present contexts, but due to the immense learning histories that humans bring with them into training, the effects of ACT work with even the most skilled practitioners as guides might initially be short-lived. Most of us return to autopiloted preoccupation with the past and future. This is not for lack of want for greater capacity to be in the moment, but simply due to the richness of previous reinforcement for focusing on events outside the present. For this reason, the exercises that work best are those that individuals can regularly practice and use skillfully at times when they are most unable to bring attention to matters of importance.

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Functional Assessment of Present Moment Deficits In the functional assessment chapter (chapter 3), you learned to listen for specific turns of phrase from which to infer a person could benefit from learning ways to return to the present moment. In particular, expressions such as “I always do this,” “She is definitely going to want that,” or “It’s just that I can’t get past what he did when I was a teenager” have topographical markers italicized here that suggest the speaker is stuck in verbal traps related to their concepts of how the past unfolded or how the future will unfold. But functional assessment should also be concerned with reinforcements that accompany living in an idealized past or excessively focusing on a conceptualized future. For example, a person might relate anything and everything happening today to watershed events from the past. In this, there is a sense that nothing could be any different, that either nothing should be different or that change would be impossible were it desired. The consequences for relating to the past in these ways appear to involve socially mediated positive reinforcement in the form of cheap praise from self and others or negative reinforcement in the form of avoiding the disap­ pointment that would follow an unsuccessful effort to bring about change. There are a few notable telltale signs that shallow reinforcements such as these are main­ taining verbal behavior related to the past or the future. Perhaps the most poignant is that the client and behavior analyst seem out of touch with each other. The client is not tacting and may not even care that the analyst is disengaged or unable to follow their train of thought. The client ambles on about events without pausing to check in with their listener and there is a sense that the narrative has been repeated so many times that it could be told when half asleep without a word out of place. Behavior analysts should be careful not to immediately assume that their failure to connect with a client is a product of the client’s attachment to a conceptualized past or future. Each of us can find ourselves triggered, confronted, or consumed by events in or outside the room in such a way that leaves us unable to be present. Noticing that there is a disconnect can be col­ lected as data from which to develop a more informed assessment. An option going forward then is to bring the disconnect to the client for inspection. For example, the analyst noticing that a skills training session with a parent is not progressing could ask a question for both to investigate together: “I’m noticing myself drift away from you right now. I’m not certain whether it’s something you are doing or it’s something that I’m going through that’s keeping me from being present with you. Maybe it’s both? I wonder whether we might take a moment to examine this. It’s curious to me and I wonder what it’s been like today for you.” Notice that the words “drift away from you” and “keeping me from being present with you” betray a sense that the behavior analyst and client are in different places, even while physically located in the same room. (The Spaces in Between Exercise can help you examine this situation in more depth and is available on the book’s website at http://www.newharbinger.com/45816.)

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Another telltale sign of disconnectedness with the present is when an individual repeatedly blames others for their misfortune. This can take many forms and the behavior can be a func­ tion of positive, negative, or multiple reinforcement contingencies. For example, a BCBA-D overseeing the work of BCBAs might notice that one certified analyst in particular blames parents for their failure to follow programs and therapists for not taking more time to teach them. The pattern seems to involve negative reinforcement in which blame is avoided by attack­ ing others. The BCBA-D might first try contingency management strategies in which negative reinforcement is available to the BCBA for alternative behavior, such as rewriting programs that parents can more easily follow and therapists can efficiently teach. But if changing the direct contingencies of reinforcement does not result in bringing the BCBA’s behavior under effective stimulus control, then an ACT interpretation might follow. In this case, the same performance might be viewed as behavior that is under the indirect control of verbally construed past or future contingencies of reinforcement. Verbal construc­ tions about the past or future lie outside the immediate stream of antecedent, behavior, and consequence. The reinforcers are therefore necessarily verbal, and though they may come in the form of socially mediated absolution from responsibility for a client’s lack of progress, the reinforcers may be self-applied by the BCBA in such statements as, “It doesn’t matter whether I get dinged for this; I’ve been trying endlessly and it’s useless with these parents and therapists.” You can hear the hyperbole in this statement and the morphine-like quality of numbness it provides leading to chronic disconnection with experience. The costs of this kind of reinforce­ ment are dear—there is little chance of finding purpose in work or contacting positive rein­ forcement in the form of client success with a program once the BCBA has resigned himself to such weak, secondary forms of reinforcement.

The General Approach to Treating Problems with Present Moment Awareness Because much of the reinforcement for behavior under the control of a conceptualized past or future is indirect, the essential ACT training strategy is to apply extinction. This is not extinc­ tion of the same variety to which one exposes a nonverbal learner. It is not attention extinction or escape extinction, per se. It is verbal extinction in which instruction is given to concentrate on something in the current context, verbal statements about the past or future are given no attention, and attempts to return to the past or future are met with a reminder to refocus upon something immediate in the present moment. A variety of formal and informal practices can be used to generate flexible attention to the present moment. Here, we will focus on using the ACT matrix to facilitate discrimination of present versus remote behavior, capturing client metaphors related to the past or future, and structured activities that bring behavior back to the here and now. Throughout, we will offer tips for contacting the now inside daily exchanges that routinely occur in work contexts famil­ iar to BCBAs.

Present Moment Awareness173

Using the ACT Matrix to Engage Others in the Now As we have noted elsewhere, the matrix lends itself to applied behavior analytic practice. It is a form of discrimination training in which the client learns to sort behaviors into those that contact positive versus negative reinforcement and into publicly versus privately observable response forms. Using the matrix, behavior analysts encountering behavior under the control of verbally construed past or future contingencies of reinforcement can address these matters directly while keeping interventions within a BCBA’s scope of practice. In the following example, an analyst pauses an ineffective parent training session in which he has been teaching a parent to treat verbal scrolling. In the process, the analyst helps the parent excessively concerned with upcoming changes in her child’s schooling to make room for the ebb and flow of her experiences, notice rumination, and inventory the costs and benefits of continuing to do what she is doing. BCBA:

Mrs. Halsey, Julia just emitted multiple mand errors. She said, “Cookie, sip, ball, water” all in rapid succession—but the item she was manding for was the chip in your hand. This is when you take the chip, put it below the table, put your other hand up to stop Julia from speaking, and count to five by putting up one finger at a time.

Mrs. Halsey:

I know. I should have this part down by now, right? I got lost for a second. Actually, I’m just completely preoccupied with the school transition we’re doing. Did you know that tomorrow Julia’s going into her new class for two hours?

BCBA:

I didn’t, but did you see what just happened? We started to talk about your focus on the scrolling correction procedure, and you changed the topic.

Mrs. Halsey:

Can we just try again? I think I can get it right this time.

BCBA:

We can. And I certainly want to—in a moment when I think we might be more successful. But this has been really hard for you, so I’d like to ask you to try something different with me first. Would you be willing to take a look at your worrying over the school transition with me?

Mrs. Halsey:

I guess it’s a bit of a problem, is it?

BCBA:

You tell me. What’s your experience been when trying to focus on other things?

Mrs. Halsey:

Well, you just saw, didn’t you? [Turning red]

BCBA:

You’ve seen me pull out this grid before—the matrix. Let’s sort where things are at. A moment ago, when you were working with Julia and got lost for a second—what were you feeling at that moment?

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Mrs. Halsey:

I don’t think I can say, really.

BCBA:

You know, that’s not uncommon. I encounter that a lot when I’m working with parents going through difficult times. In fact, it happens to me sometimes when I’m preoccupied—I know I’m uncomfortable, but I can’t even tell you where in my body I’m feeling it.

Mrs. Halsey:

Maybe right behind my eyeballs is where I feel it the most. Like there’s a pressure there, and my eyes get sore.

BCBA:

So, I’m going to jot that down right here in the lower left corner of the grid, because this is something that’s private to you. I’d never have known that you were having that experience had you not shared it with me now. What else were you experiencing?

Mrs. Halsey:

For a second, I flashed on the last time Julia switched schools. She hid her head in her hands for two weeks everywhere she went. Even at home.

BCBA:

Makes me very sad to hear about that, and even sadder to hear how that memory’s coming up for you today. And isn’t it interesting that you and I have memories like that from the distant past. Here we are doing everything we need to do to make sure Julia’s going to be successful, and yet we “flash” on the past just like it was happening here and now. [Here the BCBA makes use of a metaphor that Mrs. Halsey initiated. Later, he might pick out this same metaphor and build on it to help expand her experience of the present moment.] So, those were your private experiences at the moment Julia was scrolling. What do you think the behaviors were that I observed?

Mrs. Halsey:

You saw me getting lost. I was distracted and foggy on what to do next.

BCBA:

Certainly, those were things you were experiencing and you might have even thought I could “see” all that, but I actually saw none of those things.

Mrs. Halsey:

Oh, okay, but you did see me pause with the chip in my hand in front of Julia.

BCBA:

Yes, I saw you pause with the chip in plain view.

Mrs. Halsey:

And you saw me knit my brow and start to shake my head when I knew I was supposed to do something else. [Eyes watering] I couldn’t shake off the memory that was flashing before my eyes.

BCBA:

I’m writing all of that in the top half of the matrix, because yes, these are behaviors you engaged in that I saw. And would you say, Mrs. Halsey, that these are ways of behaving that are fully aligned with the things you told me earlier that matter most to you? The last time we pulled out this grid, you said that you want to be the best helper your daughter has in her corner.

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Mrs. Halsey:

No, I don’t suppose it is. If I were being that, I’d be focused, even when life is getting me down. [Here Mrs. Halsey is tacting behaviors that could reflect a commitment to her values. The BCBA might return to this later to seal the deal.]

BCBA:

Nice work. Excellent. I see this is paying off already. The knitting of your brow and shaking your head—those I’m drawing into the top left quadrant, because they’re behaviors I can see and that were not you being your best self. Coming back into focus when life is getting you down—that’s you at your best, living at the high end of your dream of being in Julia’s corner.

Mrs. Halsey:

Okay, but how in the world does anyone even do that?

BCBA:

Fantastic. That’s what we’re going to work on next. And we’re going to do this because without working on improving your focus, you’ll keep getting lost when memories flash you the way this last one did. We’re going to come back to scrolling correction trials, but let’s dive in just a little deeper into this business of situational awareness, being fully present in the moment, even when life is…life-ing you, okay?

The BCBA has used the matrix to set the occasion for more targeted work on the specific behaviors and stimulus events that interfere with Mrs. Halsey’s capacity to focus on learning to implement her daughter’s scrolling correction program. This is an exceptionally useful strategy, because the BCBA does not hold tangible reinforcers that are of value to Mrs. Halsey, and social praise has not proved to be powerful enough to maintain her responding. The BCBA has already broken things down to a manageable level and done pretraining. This does not seem to be a skill deficit so much as a performance deficit related to framing ABA with change and change with conditions under which her daughter has previously shut down in emotional pain. To undermine the potency of these framed relations, the BCBA might next use carefully crafted metaphors and exercises derived from things Mrs. Halsey has brought up already.

Building Exercises to Facilitate Engagement in the Now Having used the ACT matrix to facilitate discrimination of present versus remote behavior, the practitioner can move to capturing metaphors related to past and future and use these to engi­ neer structured activities that bring behavior into the present.

Using Metaphors to Engage Others in the Now As with other ACT repertoires, situationally aware behavior can be facilitated with multi­ ple exemplar training. Repeated practice during downtime when stressors are not present increases the likelihood that difficult life events will not usurp one’s attention. Instead, a person having a hard time focusing will engage in practices that bring their attention back to the present moment. Metaphors are powerful here because they are easily remembered and aid in the development of a behavior chain.

R

Try something

US/SD

Feel disengaged

Figure 10.1

Try repeating a metaphor to bring focus to the now

No reinforcement

Figure 10.1

R

SR/SD Positive reinforcement! The function of the disengaged feeling transforms

SR/SD Expand the metaphor & physicalize it

R

Positive reinforcement builds with ongoing present moment activity

SR

176 ACT and Applied Behavior Analysis

Present Moment Awareness177

In the example dialogue below, the BCBA continues to work with Mrs. Halsey, this time using metaphor to transform the function of the disengaged feeling and the relations of ABA, change, and emotional pain framed together in coordination. BCBA:

You mentioned a painful memory that distracted you when we were practicing the scrolling correction procedure. You felt like you were “flashing” on the last time Julia switched schools. I’d like for us to try and practice a skill together where we focus in on a number of flashes of experience. Would you be willing to do this with me?

Mrs. Halsey:

Sounds weird, but alright.

BCBA:

I’d like you to put your hands over your eyes and stand up… Now, if you’re willing, make a quarter turn to the right. And now, when I say “Go,” take your hands away from your eyes for a second and then cover your eyes again. Ready, Go!

Mrs. Halsey:

[Speaking with her hands still covering her eyes] I think I get it—that was like a flash of memory.

BCBA:

Exactly. What did you notice just now as you opened and closed the shutters on your eyes?

Mrs. Halsey:

It was like I was hit by a wall of colors. I couldn’t make anything out, really.

BCBA:

Interesting. Would you say it made you felt lost?

Mrs. Halsey:

Maybe for a second.

BCBA:

Let’s try it again. This time turn around in a circle with your eyes shuttered until I say stop. [Mrs. Halsey turns in a circle.] Okay, now stop and flash the shutters open and closed…

Mrs. Halsey:

It was foggier this time because I had no idea what direction I was facing. It took a second to make out what I was seeing.

BCBA:

Now that’s super interesting because before, when we were jotting things into the matrix, you said that you felt lost, distracted, and foggy.

Mrs. Halsey:

So what?

BCBA:

Exactly. So what? Now I want to ask if you’d be willing to do something a little risky. I promise I won’t let you get hurt, but I am going to challenge you to do something bold. Keeping your hands over your eyes the way they are right now, I’d like you to begin walking with me. This is your house, so you know the lay of the land. But I’m going to walk you around. I’ve got a bit of cord here [pulls out a five-foot length of cord] that I’ll ask to tie to your wrist so that I can stay apart from you as I guide you across the living and dining room areas. Would you be okay with this?

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Mrs. Halsey:

Very frightening!

BCBA:

I know! I’m actually a bit nervous about this myself, to be honest! It’s a good thing your husband, Julia, and your mother are in the other room. Maybe tell them we’re going to do this before we start. You’re going to walk, and I’ll pretty much keep my mouth shut except when I say “Go” to let you know when to open and close the shutters. [This is an important moment. The matrix and metaphors have built up to this exercise. The level of threat is substantially greater as this exercise unfolds. It is stressful for both Mrs. Halsey and the BCBA.]

Physicalizing metaphors in this way is a principal tool in ACT training that can help drive home the importance of a skill and exemplify a strategy that can be used on a regular basis to keep the repertoire fresh. (Another physicalizing exercise, called Stumbling About, is described in detail at the website for this book, http://www.newharbinger.com/45816.) In the next section, we will explore the debrief to be done after such an exercise and dem­ onstrate the means by which to transition this brief intervention from being a one-off into being a daily practice.

Committing to Daily Practice As discussed in chapters 4 and 7, the level of trust required in a physicalized metaphor exercise can range from low to high. This particular exercise, in which Mrs. Halsey will take flash photos of her surroundings, might pose a moderate level of threat for some individuals. For Mrs. Halsey, this will likely pose an even higher level of threat. This is because she has already been reactivated in session and noticed how similar the flashes of her hands against her eyes have been to the flashes of unwanted memory that stopped her from performing the scrolling correction procedure she had previously learned to use with her daughter. The following dia­ logue continues after the BCBA has led Mrs. Halsey throughout the house and repeatedly asked her to open and close the shutters over her eyes. BCBA:

Well, you weathered that just wonderfully!

Mrs. Halsey:

That was trippy.

BCBA:

It was a trip! A trip through some seriously foggy terrain, right?

Mrs. Halsey:

Lost, distracted, and foggy. That’s what you said I’d said earlier, I think.

BCBA:

That’s right. Did you feel lost, distracted, or foggy?

Mrs. Halsey:

Lost, yes. Definitely distracted.

BCBA:

What were you being distracted by?

Present Moment Awareness179

Mrs. Halsey:

Well, you weren’t talking, so I was listening to Julia and my husband Paul playing in the other room. And when I was paying attention to them I kind of lost my balance at one point.

BCBA:

Interesting.

Mrs. Halsey:

And when I flashed my eyes open I had no clue where we were. Honestly, had I been paying more attention, I might have known where we’d be, but I was—

BCBA:

Distracted!

Mrs. Halsey:

Oh, crap—I can see where this is going.

BCBA:

Now I imagine that if we did this again, you’d behave somewhat differently?

Mrs. Halsey:

I’d pay more attention to what we’re doing.

BCBA:

Of course. Because those flashes of light and color—

Mrs. Halsey:

They’re like the memories I get hit with.

BCBA:

Can’t you just turn those off?

Mrs. Halsey:

I don’t know. Can I?

BCBA:

Have you ever been able to do that?

Mrs. Halsey:

I don’t think I ever have.

BCBA:

Nor I. Those memories you have of when Julia switched schools, I have my own similar bad memories. They pop up when they pop up. They’re like pop-up ads on the internet.

Mrs. Halsey:

Which I never pay any mind to.

BCBA:

Say a bit more about that.

Mrs. Halsey:

When I see ads on Facebook or in The New York Times, I just don’t pay any attention… Oh, wow. I think I get it. So you’re saying that I can’t really stop old memories from popping up, but I can choose not to give them my attention.

BCBA:

That’s spot on. And if you were to place your attention elsewhere, where would that be?

Mrs. Halsey:

On the work I’m doing right now. Walking with you guiding me, working with Julia… whatever.

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BCBA:

So. This is where the rubber meets the road. Are you willing to have these memories without trying to push them away by stopping what you’re doing? Because that might be the only way to stop the memories from intruding—just stop doing ABA with Julia. And from what you’ve told me, that wouldn’t represent being “in her corner.” So, given that they’re going to show up if you do ABA work with your daughter, are you willing to have these memories and bring your attention back to the work at hand when you notice yourself getting lost, distracted, or foggy? [The BCBA pulls from previous work they’d done identifying Mrs. Halsey’s values to anchor the current experience in a broader hierarchical frame of importance.]

Mrs. Halsey:

That’s what this has been about, right?

BCBA:

And to do that, would you also be willing to practice this shuttering exercise a few times a day? You probably won’t ever forget what we did here today, but it will help for you to get into the habit of practicing being focused in the moment, or rather, coming back to the present moment when memories and other distractions pull you away.

Mrs. Halsey:

This actually makes sense to me!

BCBA:

I’m glad of that. But will you make a commitment to me to practice this, say two times a day for two minutes at a time? If you’re down for it, I’d like you to collect a little data. Nothing fancy, just track the number of minutes you closed your eyes and unshuttered them while doing something else that you could do with your eyes closed.

Mrs. Halsey:

What could I do with my eyes closed?

BCBA:

Fold laundry? Walk a straight line in the backyard? Put away the plastic dishware?

Mrs. Halsey:

I’m willing to try that.

BCBA:

Super. Well then. I think we’re ready to come back to another round of scrolling correction practice. You game for that?

Guided Imagery: Bringing Attention to the Now Physicalized metaphors are helpful but not always practical, such as when a client is resis­ tant to getting out of their chair. An alternative way to facilitate present moment awareness is to use guided imagery in a brief meditation. Following is a brief guided meditation exercise that initially helps narrow stimulus control that is unworkably diffuse. Subsequently, the exercise aims to broaden stimulus control incrementally. As always in present moment work, the ulti­ mate aim is flexible attention to the now. Here is a script you might use.

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I’d like to invite you to join me in a guided meditation. This will take only a few minutes. It’s a bit unusual for behavior analysts to ask individuals with whom we work to meditate, but if you would, give it a shot and see if this process helps you hone your focus in a way that has eluded you when we tried other approaches. There are strong behavior analytic data that suggest this could help you. But please don’t take my word for it. Rather, it’s important that you pay attention to your experience. I’d like to ask you now to close your eyes. Of course, you don’t have to; there are no “have tos” here. If you don’t care to, you could fix your gaze on a point on the wall in front of you. Take a moment now to position yourself in your chair. I find it’s best to sit upright, with no more than the small of your spine touching the backrest of your chair. If you would, settle both feet firmly on the ground and your hands gently into your lap. Notice any part of your body that is at rest and comfortable. Bring your attention slowly to that part of your body. See if you can place your attention right square in the center of the comfort zone. What is the temperature like there? Is there any tingling? Any pulse that you can contact? Is it possible to move your focus to one side of that zone and keep it hovered at that edge? Keeping your attention now at the razor-sharp edge of that area that is comfortable, can you now work your focus along the edge in a circle, tracing it without touching it, tracing it from one end to the other and back? You might notice an urge to move. It’s possible that in giving this area of your body all this attention, it has become a bit uncomfortable. If you’re willing, just notice that urge to move and maintain the quiet posture that you’ve held thus far. There’s nowhere to go. Nothing to do but notice what shows up. Now, if you’re at all like me, there might also be some other part of your body that is rather uncomfortable, for whatever reason. Maybe this is a part of your body that often carries stress. Bring your attention gently to this part of your body. Can you iden­ tify the size of the area that is discomforted? Can you bring your attention to the center of that field? Your hands are quietly positioned in your lap, and without moving them at all, see if with your imagination you might be able to use your fingers to massage that area of your body that is uncomfortable. B. F. Skinner called imagining like this seeing in the absence of things seen. It is operant seeing, in the sense that because of a history of rein­ forcement for running fingers against tired parts of your body in the presence of pain or discomfort, you can feel your fingers there, pressing against the area that is ill at ease, bringing it some relief. Go ahead and knead this area of your body or give it a scratch if you’re noticing an itch, but do so using only your imagination. The sensation of calm and relief may or may not last. This is not about feeling better. It’s about feeling better. It’s about noticing what’s there in your body without trying to change it at all, without making it stronger or weaker, better or worse. It’s a data collection exercise, if you will. A method of coming into contact with aspects of your experience that you may not ordinarily pay attention to.

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One last thing before we complete this exercise. You may be noticing your mind wander. That’s normal. And there’s but one thing to do when you observe your thoughts drifting away—come back to the sensations in your body. When you drift off, come back. Remembering something you’ll need to do later? Come back to the now, to the sensations in your body. Where are you at rest? Where in your body are you experienc­ ing an urge to move? Just notice. Now whenever you are ready, I invite you to slowly open your eyes and bring your attention to the room surrounding you. Go ahead and stretch out your limbs. And after that, please take a few moments to complete the following few questions about your experience. There are no correct or even more correct ways to answer these questions. They are intended to help clarify what you have experienced and what you might want to try more or less of when you practice this on your own: 1. Were you able to notice areas of your body that were comfortable? Could you bring your attention to the center of that zone of comfort? 2. Were you then able to shift your focus to an edge of the area of comfort? Were you able to trace the edge around from one part to another and back? What did you notice about the sensations in the comfortable area when you did this? 3. What was it like engaging in the same actions—finding the center, an edge, and tracing the outer rim of an area of discomfort in your body? How, if at all, did your experience change as you did this? 4. When using operant seeing, were you able to bring changes to the sensations in your body? Did you have the sensation that you were kneading or scratch­ ing or otherwise applying pressure to your skin, when you were not in fact doing so? 5. What might you learn about yourself, about your body, about your capacity to bring changes to your body’s sensations from this exercise? 6. Would you be willing to try to repeat this on your own once a day for a week to see what else opens up? If so, what time of day? What data will you collect for the purpose of generating a sense of the progress you are making? Who will you tell to bring some public accountability to the work you are doing with this ongoing exercise over the next week? How will you measure whether this practice is improving your situational awareness? Another exercise using physicalized metaphor, the Groucho Marx Walk Exercise, is avail­ able on the website for this book, http://www.newharbinger.com/45816. You can use the same questions above to debrief that exercise as well.

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Core Competency Practice As in the previous chapters, this section contains a brief description of a clinical situation fol­ lowed by dialogue that ends with a client statement. After that are questions that offer you practice at writing out fitting responses that reflect the competency and rationales for your answers. In these exercises, maintain a focus on the repertoire at hand (in the current chapter: present moment awareness) in order to build skills sequentially. At the end of the chapter, look for the model responses and compare them to your responses. There are limitless ways to approach these issues; no one way is right or best. COMPETENCY 16: The BCBA can defuse from client content and direct attention to the present moment. CLINICAL SITUATION: A BCBA is assisting a behavior interventionist deeply dug in after an insulting comment made by a parent several months ago. Interventionist:

I get over what she said, and then when she comes in the room while I’m working, I hear her saying it all over again. Even though she’s not saying anything out loud. I remember the way she tilted her head, lowered her voice, got in my face, and said, “What do you know about raising children?”

BCBA:

It’s a powerful memory. Larger than life.

Interventionist:

Like a twenty-foot statue in the room leaning over my shoulder. I just want to get the hell out of there when I think about how she treated me.

1. Write what your response would be. Your emphasis should be on competency 16. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 17: The BCBA brings their own thoughts or feelings in the moment into the therapeutic relationship. CLINICAL SITUATION: This dialogue continues where the dialogue for competency 16 left off. BCBA:

And talking about how she treated you—do you think that’s going to help in our supervision meeting today?

Interventionist:

I guess not.

BCBA:

But it’s something that comes up a lot. It’s a bit of the past that keeps showing up in your present, isn’t it?

Interventionist:

All the time. If I could shut it off, I would.

BCBA:

I started doing this work a little later in life, so I never had a parent look at me the way she looks at you. I feel a little lost trying to imagine what it’s like.

Interventionist:

It’s totally discouraging.

BCBA:

Now that resonates.

Interventionist:

I feel like I made a bad first impression and that just messed me up for life with her.

1. Write what your response would be. Your emphasis should be on competency 17. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 18: The BCBA uses exercises to expand the client’s sense of experience as an ongoing process (e.g., mindfulness exercises or imagery exercises that support the client in focusing on the ongoing flow of internal experiences). CLINICAL SITUATION: This dialogue continues where the dialogue for competency 17 left off but occurs a little later in the session. BCBA:

I’m getting the sense that once you’ve focused on this memory, it pretty much dogs you for the rest of the day, no matter who you end up working with after you leave that house. Am I on the right track here?

Interventionist:

You have no idea. It’s much worse than that, even. It’s not really that I feel followed. It’s more like I feel her lording over me wherever I go.

1. Write what your response would be. Your emphasis should be on competency 18. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 19: The BCBA detects when clients are drifting into a past or future orientation and teaches them how to come back to the present moment. CLINICAL SITUATION: This dialogue continues where the dialogue for competency 18 left off but occurs a little later in the session. BCBA:

So, this has been great. You looked at yourself from the eyes of several kids you’re working with today, from your own eyes of age looking back at this moment twenty years from now, and from my perspective, which you captured quite accurately, I must say.

Interventionist:

I guess I look pretty different, depending on where and when you’re looking from.

BCBA:

In the present context, right here and now, what does that broader perspective open up for you?

Interventionist:

Look, I appreciate what you’re trying to do, but she really messed with my head. I mean, I’m only thirty-five and I could still have kids, but I didn’t get married when I had the chance and she’s right. When I could’ve done things to have experiences like other people have at my age, I didn’t.

1. Write what your response would be. Your emphasis should be on competency 19. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 20: The BCBA practices and models getting out of their own mind and coming back to the present moment in session. CLINICAL SITUATION: Rudy is a ten-year-old boy with autism who is unwilling to go into the schoolyard to play with others for fear that one of them might hurt him. He is emotional, talks very fast, gets out of breath, and slaps himself on the head repeatedly when asked to go outside. The BCBA has been called to his classroom to help, since there will be no adults in the room during recess to oversee the child’s safety. Rudy:

I can’t take it! I can’t breathe! I don’t wanna go out! I’m not going! They can’t make me, and neither can you.

1. Write what your response would be. Your emphasis should be on competency 20. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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Core Competency Model Responses Additional model responses are available at http://www.newharbinger.com/45816. COMPETENCY 16: The BCBA can defuse from client content and direct attention to the present moment. Model Response 16a BCBA:

I’m certainly feeling the looming presence of that statue. I want to get out from under it by coming up with a rule for what to say to her and how to say it. Like if we figure out exactly what to say to her, we could just wheel the whole thing out of the room. But if we could do that, I imagine we’d already have done that, wouldn’t we? What if we were to try something different? Let’s say, right now, she’s here. Like a statue, lording over you. I’m going to stand up and be her for a second, with that look she gives you and the tilted head. What are you experiencing—right this moment? What are you tuning in to in your body?

Explanation: Behavior is probabilistic and even the best treatments do not always impact the behavior of

others as intended. When they are easily in our grasp, we might manipulate the direct contingencies of reinforcement. Unfortunately, we do not always have opportunities to alter motivational, discriminative, and reinforcement variables. Such is likely the case with the mother of the child receiving services here. The interventionist wants to apply rules that govern what to say, when to say it, and the tone of voice to use. Strategies such as these could be very useful in some circumstances. But in this situation, they are likely to be folly. The mom in this case is likely to counter-control the most skillful behavior change efforts, and without access to her reinforcers, a different tack is required. The BCBA instead aims at the interventionist’s relationship with the past. Bringing her focus on the present moment places talk about the past on extinction and offers reinforcement for talk about the here and now. Evaluations of her past experience and the story she is telling about it are apt to recede in importance. Simultaneously, acknowledgment of her present experience and recognition of its importance toward valued ends are likely to move toward the center of the picture.

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COMPETENCY 17: The BCBA brings their own thoughts or feelings in the moment into the therapeutic relationship. Model Response 17a BCBA:

I started doing this work a little later in life, so I never had a parent look at me the way she looks at you. I feel a little lost trying to imagine what it’s like.

Interventionist:

It’s totally discouraging.

BCBA:

Now that resonates.

Explanation: Sometimes, to ignore the disparity in our perspectives and experiences is akin to the old

expression “ignoring the elephant in the room.” A simple acknowledgment of this can open a client up to the present moment and bring awareness to emotions and experiences that might otherwise go unnoticed.

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COMPETENCY 18: The BCBA uses exercises to expand the client’s sense of experience as an ongoing process (e.g., mindfulness exercises or imagery exercises that support the client in focusing on the ongoing flow of internal experiences). Model Response 18a BCBA:

Well, here we are. You had an experience some time ago and the memory’s lording over you, keeping you from doing your best work. Let’s see what happens when we get really close to this thing, shall we? First of all, how tall does she seem to you?

Interventionist:

I’d say about ten feet or so.

BCBA:

And what colors do you see looking at it?

Interventionist:

She was wearing a bright red shawl, one that looked really expensive, so that’s the color I see when I think about it.

BCBA:

What does her voice sound like?

Interventionist:

She dropped her voice low, and I hear it low and slow.

BCBA:

And what kind of smells were you present to?

Interventionist:

Oh cripes, I remember her perfume. It was really strong. It was like lemony but alcohol too.

BCBA:

Excellent. And if her son were here right now and you were working with him with all of this memory in your face, how might you be performing?

Interventionist:

If I perform like I have been, it wouldn’t be good.

BCBA:

I get it. That’s how this has been. So, let’s take this another step forward. Keeping all of that memory just as it shows up for you in the present, this looming statuesque memory, take a look around you now. Can you point out something you see that you haven’t paid any attention to until this very moment?

The BCBA leads the interventionist through a series of observations of color, texture, sound, and smell in the current context. BCBA:

So now I’m really curious. Here’s this memory lording over you, mocking you in a low, slow tone of voice, bright red, lemony…and all these other things you’re present to right here, right now. What’s opening up for you in this experience?

Explanation: In all probability, that memory is going to be back in the future. The layering in of an active

awareness of what’s here right now adds to the experience in a way that might serve to dilute the aversive functions of the memory of being ridiculed by the parent.

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COMPETENCY 19: The BCBA detects when clients are drifting into a past or future orientation and teaches them how to come back to the present moment. Model Response 19a Interventionist:

Look, I appreciate what you’re trying to do, but she really messed with my head. I mean, I’m only thirty-five and I could still have kids, but I didn’t get married when I had the chance and she’s right. When I could’ve done things to have experiences like other people have at my age, I didn’t.

BCBA:

Fascinating! We just spent a good five minutes checking out different perspectives, and what just happened? You turned the car around and floored the accelerator to get back where we started. Is this where you really want to be?

Explanation: Past behavior is the best predictor of future behavior, so these kinds of client moves are to

be expected. The BCBA here is ready for this and responds by asking the client to tact the reinforcers she wants to work for. As is, these kinds of experiential avoidance moves have not been paying off for her. The BCBA is offering an appetitive alternative, if only the interventionist will return to the present moment.

COMPETENCY 20: The therapist practices and models getting out of their own mind and coming back to the present moment in session. Model Response 20a Rudy:

I can’t take it! I can’t breathe! I don’t wanna go out! I’m not going! They can’t make me, and neither can you.

BCBA:

I know! I know! I see it! You’re out of breath! Rudy, can I tell you something? I feel out of breath right now. I’m worried this could be like last time when you started slapping yourself and it took a long time for you to calm down. But here I am. I really like you and I want to help you, so here I am. And look at you right now! You’re calm and you’re not hitting yourself.

Explanation: The BCBA is walking through a process that Rudy will learn, most likely over an extended

period of time through multiple exemplar training. The first exemplar is here: the analyst refrains from giving Rudy easy solutions to the difficult playground situation, and instead makes the bold move of modeling coming back to the present moment, and being willing to have difficult memories and emotions, in service of a valued client’s growth and development.

CHAPTER 11

Flexible Perspective-Taking

Take a moment to imagine Alex, a kid who is thin, has long, sinewy muscles, a thick mat of brown hair, is often the first chosen for sports teams, dominates on the playing fields, and is equally strong in classroom discussions. What do you see as you imagine this young person? When I first encountered this thought experiment, I saw a boy in his teens. Nothing wrong in that. But when I then learned that the person leading the exercise was not describing a boy, I got a strong whiff of the way my social conditioning led to inaccurate automatic verbal catego­ rizations about others. In fact, the facilitator was describing a person who was transitioning. Most people in the group saw a boy. Some saw a girl. Only a handful envisioned a person free of the gender binary. Fortunately, the facilitator did not make me or anyone else wrong. We are the products of our learning histories. If we are to learn to see ourselves and others differently, it is this condi­ tioning that needs to be addressed. This is just one of the profound heartbeats of the work you might do in ACT aimed at softening hard, edgy social categorizations we rapidly make about ourselves and others. In Science and Human Behavior, Skinner devoted an entire chapter to “self-control.” Interestingly, it is the only chapter with a title that is in quotation marks. He made the point that we do not control our own behavior. Instead, our self-controlling responses are under the control of the same environmental factors as any other behavior we emit. In other words, the environment controls our self-controlling responses. Skinner asked, when a person jams their hands into their pockets, who is controlling whom? We say the person is practicing self-control; the person is causing themself to act. But Skinner suggested that the self is a hypothetical cause of action. So long as we fail to recognize the external variables that account for our behavior, we attribute our actions to our will, an originating agent within. As such, we dualistically split ourselves into a controller and a controllee. Instead of splitting self into two parts, a controller and a controllee, Skinner showed that a unified view of self is possible by referring to four environmental controlling variables: 1) common modes of action (you might engage in the same behavior that others do when you go to the beach, and thereby call yourself a surfer), 2) a particular discriminative stimulus (in my teens, I behaved differently in the presence of my family than I did around my friends), 3) motivating operations (if you regularly see me a half hour after I’ve eaten, you’re likely to label me a sluggish

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person), and 4) emotional variables (under certain eliciting conditions, a timid person will behave courageously). The “initiating agent” concept of self leads us to expect that others will perform consis­ tently with our view of them. We say of one that they are “a timid person” and of another that they are “a grumpasaurus” when, in fact, these personalities are flexible and are observable as a function of changing environmental variables. Skinner suggested that we come to know ourselves when a verbal community asks such questions as “What did you do?” or “What are you going to do?” In these situations, an accurate self-report is likely to be reinforced. We are further trained at early stages in our development to render self-reports regarding private stimuli to which we respond and private behavior that we emit. The accuracy of our reports is a function of the training and reinforcement we receive. When we laugh, our parents respond that laughter is collateral to humor and teach us the words for this by saying, “You find this funny!” When we bear a public accompaniment such as a bruise, we are told, “Oh, that looks like it must hurt,” which teaches us additional means by which to tact private stimulation. Teachers extend common tacts to further help us describe the quality of our experiences; after being cut by a sharp knife, we are told, “That must be a sharp pain!” And finally, we learn to emit vocal responses about what we are going to do, such as how we are going to move the pieces on a chessboard, and later, we are taught to diminish our responses so that no one will prematurely know of our subterfuges. Skinner thought that com­ bined, these four modes of training result in a repertoire of self-knowledge. RFT extends Skinner’s analysis by suggesting that framing with respect to person, place, and time based upon symbolic cues for the particular relation and context is the means by which the self-knowledge training Skinner detailed takes root beyond the formal contexts in which the training described above occurs. In other words, stimulus generalization provides a starting point, but to fully account for the expansive way that verbal learning leads to a selfknowledge repertoire, additional attention must be given to the means by which a verbal self emerges. That is, we need to account for the way a selfing repertoire that is not in the presence of MO, SD, and CR variables continues to evolve after these environmental determinants have left the immediate surroundings. It is the fact that self does not remain static that requires addi­ tions to Skinner’s account. External environmental variables may remain stable, but the self changes. Alternatively, external variables can change, while the self remains stable.

The Importance of Flexible Perspective-Taking Few would argue the importance of gaining a sense of self. Nevertheless, as you have gleaned from the section above, self from a contextual behavior analytic lens is unlike other approaches to this topic. For one, the notion of self as behavior, or selfing, is uncommon. Yet this is vitally important because it leads to two very important suppositions. First, because selfing is behavior, uncovering its environmental determinants and second­ ary verbal behavioral influences means it is possible to change what others see as your

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personality and to help others change theirs. Most nonbehavioral approaches examine the impact of remote variables such as heredity and culture upon personality. The implication is that the self is a relatively stable entity that perhaps can be altered slowly over time in some ways, but not in others. In contrast, the behavioral view is that self is behavior that is largely under the control of local variables and is therefore quite malleable, even if heredity and culture are there in the background. Second, a contextual view is that the behaving organism is an integrated system of responses that repeatedly acts and is met with reactions from the environment over time. Ongoing con­ figurations of reaction from the environment as well as persistent arrangements of antecedent stimulation elicit and evoke characteristic patterns of a human’s behavior. In other words, because much of the world in which we respond operates in predictable ways, we too tend to act predictably. As such, our verbal descriptions of ourselves and our very experience of ourselves remain fairly stable. Even though our experience of ourselves and our behaviors of selfing can be remarkably malleable, we may not appear to change much from moment to moment or day to day. At least, when we do, we may not observe the changes because so many other aspects of the experience we have of ourselves remain stable. And, because framing relationally is, as the name implies, the framing of a structure of verbal relations, changes to any small section in the larger expansive structure of our selfing repertoire appear minuscule until cumulative or punc­ tuated experiences lead to transformations that are more globally obvious. To review, we are at once changing all the time and stable over time. These two facets of selfing have many important implications for the way we engage in derived relational respond­ ing with respect to ourselves. In RFT parlance, selfing is deictic framing in accordance with overarching hierarchical contexts. What this means is that you observe your self in time and space, and either time, place, or self will serve as the pivot point that organizes interaction of the three. For example, perhaps you see yourself as rooted to a small fishing village that for at least the last two hundred years has been home to no more than a thousand people. In this case, place is the hierarchical apex that organizes person and time. Alternatively, a client’s grandfa­ ther may see himself as part of an older generation of Spaniards who had no word for autism in his country and cannot see what all the fuss is about your client’s special needs. To this indi­ vidual, time serves as the pivot point that establishes coherence with self and place. Hierarchical deictic framing can take three forms that are of importance in ABA work with others. When you evaluate a client’s selfing repertoire to be rigid, it is useful to further classify which of three aspects of selfing is being used excessively, and which is deficient. Self-as-content is perhaps the first of these to emerge. Repeated exposure to certain kinds of experiences, ongoing patterns of action, labels from others, and other such events lead to the development of an abstract sense of self as a thing. We are labeled and often label ourselves as a this or a that. At times, these labels are particularly useful. If you are reading this book, you are likely a behavior analyst, maybe an ACT practitioner or a contextual behavior scientist. These are useful self-labels in the context of work. But they can be extended too far. If you are invited to a cocktail party at the neighbor’s house and you mention that you are “engaging in some respondent behavior that’s getting in the way of your performance,” well, I expect you

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might not be invited back anytime soon. That kind of talk, possibly appropriate when giving a scientific lecture, is out of place at the cocktail party and reflects an overidentification with your self as a scientist. You may encounter clients who label themselves as autistics and prefer to be talked about using this identifier. This can be empowering for them, compared to the label “person with autism” that has been considered most respectful until now. A parent may say to you that “I am only a mom,” and although the identity of being a mother may be richly appeti­ tive in some contexts, the use of the word “only” in describing herself to a professional may represent a tightly constricted and possibly subordinate sense of self. The consistency of a con­ ceptualized sense of self can thus be healthy or not, useful in social and work contexts or not, facilitative of behavior that contacts reinforcement or not. The role of the behavior analyst in working with a client, parent, or staff member who overextends or underutilizes their sense of self-as-content is to aid them in examining contexts in which these labels and associated behav­ iors work or do not. After that, the behavior analyst can contrive opportunities for the learner to try behaving consistently, behaving in new ways, or alternating between these poles to see what works in which contexts. Can you remember yourself as you walked into school the very first day of kindergarten? Do you recall the funny hairdo you had, the shoes you picked to wear, the way your clothes felt? The you that recalls this time in your life is the same you that had that experience there and then. The you that is looking out at the world from behind your eyeballs here and now is that same you who saw the schoolhouse, other kids, and your teacher so many years ago. This con­ tinuity of experience is referred to in ACT as self-as-process. It is an ongoing sense of self that seems to be unfettered by the ball and chain of current circumstances. An RBT that can see themself as unfolding in this manner can imagine themself a supervisor in two years and a clini­ cal director a few years after that. A grandparent with this kind of process orientation can see themself as an aspiring dancer, a rising graduate student, a young partner with children on the way, a caregiver for a grandchild with autism, and a retiree in a short time to come. Such extended temporal perspective can also have a dark side. Imagine a child who does not want to get bigger because their mother will no longer care for them when they do. Imagine a teacher who labels themself incompetent because of a few tough years they had getting started—a decade ago. In stride, self seen as consistent over time can be beneficial, but overextended, this aspect of selfing can be quite harmful. If you could step away from yourself and observe your actions in the unique set of circum­ stances you are operating in, you would potentially witness yourself as interacting in a style that fits the occasion. Zooming out a little further, you might see a slightly different pattern of action befitting the time of year and region of the nation in which you live. Fast-forward four months and you would see you in a thoroughly new situation, perhaps a new location, and certainly a different time of year. Across these changes you can eye yourself behaving differently, dressing differently, and feeling differently about yourself. This is self-as-context, which is likely the last of the selfing repertoires to emerge. Seeing yourself as a set of actions that change with the scenery is a behavioral view of self that requires an earlier development of a variety of different concep­ tualized self-repertoires plus a corresponding view of yourself as a stable locus of perspective

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over time. For this reason, it is not an aspect of selfing that likely emerges early in one’s life. To be able to view yourself as adaptable to novel situations is obviously beneficial if you consider the way that life’s situations change over the course of time. It seems likely that this capacity to zoom out and see yourself inside a much bigger picture is central to the experience of being part of something that is greater than you in this moment. The sense of transcendence that characterizes spiritual experiences seems to emanate from this skill of stepping outside of the mundane and observing from the sublime. Of course, even this composite repertoire that in many ways is the apex of the three selfing repertoires has a dark side. It is possible to become too malleable, too separated from the immediate context. It is a short jump to madness when you are no longer moored to well-established conceptualized iden­ tities and the ongoing you that is learning from experiences across your lifetime. In this regard, you can imagine a young autistic girl with strong verbal skills but who lacks a grounding sense of being a learner or an artist, who does not recall herself at earlier times and does not imagine herself as an independent grown-up. She changes with circumstances, but her changes are inconsistent, sporadic. It is almost as though she is an entirely new person every week for whom efforts to build an ABA program with preference-driven reinforcers, coherent schedules, and effective contingencies are just out of reach. It is this child who might benefit from programming that progressively builds self-as-content, self-as-process, and self-as-context while simultaneously correcting for overextension of each of these three aspects of selfing. There are two more features of flexible perspective-taking that are important to discuss. One involves compassion for others; the other is self-compassion. As noted earlier, we are at once changing all the time and stable over time. These two facets of selfing have important implications regarding our capacity for relating to others. Because it is the verbal community that asks us questions that lead us to perceive ourselves as distinct from others, there can be no self without other, no “I” without “you.” As such, each of the three aspects of selfing just described pertains to how we view others. Flexible perspectivetaking of others involves other-as-content, other-as-process, and other-as-context. We can see others as things just as we may see ourselves as the labels that others give us. Alternatively, we may give others useful labels that change as circumstances change. We can see others as stable over time in a way that doesn’t allow for them to age and learn. But we can learn to view others as an unfolding process that is at once stable and also in development. It is possible, too, to view others as changing in context and to trust that their actions will befit their circumstances. However, it is also possible to inaccurately view others as being whimsical and unable to find a stable core, even when they are consistent in their developing responses to a turbulently chang­ ing world. Flexibly relating to others makes it possible to develop a loving stance toward them, even as they stumble, perhaps even as they do harm to you. You might observe that everyone is doing the best they can, and everyone is having a bad day. No one is getting it right by close of busi­ ness on Friday. Everyone is a piece of dirt once in a while, and we all return to dust in the end. All people live in the current moment with the cumulative learning of their lives, and in that, their views are not omniscient. There is time yet for all of us to lean into the current context in

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new ways. We don’t all have the skills or access to training. Maybe that is where the communi­ tarian vision of ACT kicks in. By showing others a touch of kindness, we teach and grow a world more responsive to suffering, more capable of healing, more open to diversity. The corollary to compassion for others is self-compassion (Yadavaia et al., 2014). An out­ growth of flexible perspective-taking, self-compassion predicts a variety of behavioral and psy­ chological outcomes, such as making time for self-care and values-based activities. As a distinct selfing repertoire, self-compassion seems to involve defusion from self-criticism and unbending self-categorizations. You and I can behave poorly at any given time, but that doesn’t make you or me a (fill in the expletive of your choice) forever. Perhaps self-compassion is the combination of flexible self-perspective-taking plus self-kindness. Thus, it is likely more than just being kind to yourself. It is that in concert with responding to your own responding; it is seeing yourself with all the warts and blemishes that you have and offering yourself love, too.

Functional Assessment of Flexible Perspective-Taking Deficits The section above illustrated key areas of ACT functional assessment for selfing issues experi­ entially. Below, these issues are presented diagrammatically for assessment purposes. Consider Mavis, a fifteen-year-old who identifies as a girl and who is adamant about drop­ ping out of school. The decision is distressing to her and, though sure she wants to do this, she has not yet thought through the impact dropping out will have on her life or on her family. Mavis says that she is not good at math, is a creative, and is an autistic. She resents the way that schools label people and put everything important into boxes. She says that these characteris­ tics have always been who she is. She tried in school, but in recent years she has tuned out during classes. She is anxious when it comes time for tests, often gets stomach cramps or migraines on test days, and calls in sick. Telling her family and friends that she is going to drop out is hard and she has not yet approached the subject. But she cannot understand why they are always expressing so much concern about her. Her teachers and family don’t get it. Their approach to school and to her is wrong. In her view, she is who she is and there is no problem. Mavis also contends that her situation is unique because her creativity causes her to be unable to relate to the formal logic of math and her autism causes her to perceive the world more in terms of physical colors and shapes than abstract numbers. Because of this complex web of rela­ tions that make up who she is, Mavis says, “I’m not cut out for school.”

RFT and Selfing The hyper-dimensional multilevel framework (HDML; Barnes-Holmes, Barnes-Holmes, & McEnteggart, 2020) identifies four dimensions along which relational framing can be assessed. To evaluate issues regarding inflexible selfing, it is useful to consider these four dimensions as they pertain to self-as-content, self-as-process, and self-as-context. The two tables below help

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clarify assessment using the HDML and an applied framework to identify observable, measur­ able intervention targets.

HDML Assessment Dimension

Tells

Assessment Criteria

Coherence

• I’m no good at math

• More than one rigid self-statement

• I’m a creative

Derivation

• I’m an autistic

• Self-statements in different life domains congeal in rigid patterns

• This has always been the way I am

• Verbal relations were derived in the past • In the present, they are applied to novel situations without attention to contextual nuances

Complexity

• I’m not a math geek because I’m a creative • Because I’m autistic, I see in colors and shapes rather than numbers

Flexibility

• There’s really no other way for me to be • I am what I am • I’m not cut out for school

• Each node of the verbal network is linked through an intricate web of causal, oppositional, and hierarchical frames • Behavioral options are restricted due to the complex, long-standing, and logical interaction among the different aspects of conceptualized self

As a general rule, high coherence, high complexity, low derivation, and low flexibility in self-statements are warning signs. As depicted above, Mavis shows high coherence and com­ plexity coupled with low derivation and flexibility. Thus, all four HDML categories suggest that her selfing repertoire is likely to be distressing to her. As a general decision-making heuristic, if two or more of these four classes of relational dimensions are checked, then a selfing interven­ tion might be warranted. The next issue at hand is identifying clinical targets. McHugh et al. (2019) propose four areas in which to focus intervention: ability to discriminate experiences and accurately label internal experiences, deictic relational responding, self-related coherence issues, and contextual sense of self, diagrammed with Mavis’s example in the following table.

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Identifying Intervention Targets Target

Tells

Assessment Criteria

Discriminating Overt and Covert Experiences

• I tune out during classes because I’m not a school geek

• Weak discrimination of connections between overt and covert behavior

• I really don’t know why I feel so anxious

• Does not discriminate differences between experiences of herself at different times in her life

Deictic Relational Responding

• I don’t know why they’re so upset

• Does not understand others’ perspectives

Self-Related Coherence Issues

• I am not a math person, so of course I’m a creative because I’m the opposite of logical

• Verbal relations fit into tightly connected categorical systems

• As a feeler and autistic, I naturally don’t relate to the boxes teachers put everything in Contextual Sense of Self

• My teachers and parents are wrong about me • I am what I am

• Lacks awareness of the boxes she puts others into

• Lacks awareness of different aspects of self related to changes in context • Poor hierarchical framing of alternative selfing repertoires that may help differentially in family, school, and friendship domains

Mavis’s statements about who she is as a determinant of how she acts show poor discrimina­ tion of the concurrent nature of her emotions, somatic complaints, and disconnected behavior during classes. Her confusion over others’ concern for her reflects a deficit in deictic relational responding. This is directly related to her strong conceptualized sense of self and conviction that others are wrong about her—taken together, these clues suggest that Mavis has a limited repertoire for contextual self-perspective. A final issue is the cumulative, lockstep way Mavis’s self-related statements cohere. Combined, this assessment reveals four distinct indirect-contin­ gency targets that an ABA worker might address in working with Mavis on her decision to drop out of school.

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The General Approach to Treating Inflexible Perspective-Taking The case made throughout this book is that ABA practitioners can conduct prevention-based ACT work that is more general in nature or intervention-based ACT work that is based on careful and ongoing functional assessment. In each case, the focus of ABA is on observable, measurable behavior that is of social relevance and can be analyzed for change in relation to exposure to the treatment. When conducting intervention-based ACT, it is particularly impor­ tant to stick to intervention targets that satisfy these criteria. Flexible perspective-taking inter­ ventions are commonly built into early learner ABA curricula, but there is a dearth of intervention tools available for helping those with complex repertoires to rehearse complex selfing skills, jump-start stalled perspectival repertoires, and address subtle gaps or treatmentresistant behavior. Although it is important to address this, there is a distinct hazard that doing so could lead into talk therapy, which is outside ABA’s scope of practice (see the final chapter of this volume for a full discussion of this topic). Although the possibility of slipping into talk therapy is present during all ACT interventions, self-as-context interventions may be particularly prone to this. Therefore, it is important to continuously ask whether the selfing skill that you are addressing is directly linked to an overt behavior that the client needs help addressing. In all but the rarest cases, the target should be a behavior about which the client expresses distress. Even if they do not immediately wish to change selfing behaviors, their distress may open the door to interven­ tion. But if they are not troubled by their situation, perspective-taking interventions are unlikely to gain traction and could traverse outside the behavior analyst’s scope of practice. A second point worth mention is that selfing issues are often directly connected to shame. That is, a sense of being bad at the core, unlovable, too little, too much, too serious, too too too is at the heart of perspectival work. It is often deeply unsettling to look at these thoughts, which can be so painful that a common defense is to push blame onto someone else. Indeed, others are there too, and they play a part in the unfolding drama of our lives. But to the extent that your client focuses their energy on complaining about others’ behavior, they will not attend to the relationship between their own covert perspective and overt behavior and the relationship between these behaviors and the outside environment in which they are emitted. Thus, a criti­ cal aspect of the general approach is to ask the client to engage in exercises that target their own perspective as a target in itself. Keeping the focus on themself and those aspects of the environ­ ment they can manipulate to help themself see themself and others differently has the highest probability of helping within the context of ABA intervention. Relatedly, interventions that involve more limited talk about their perspective and more active movement that changes their point of view fosters healthy perspectival shifts. Debriefing ways to make use of insights that come from these active exercises will have more power than talking about one’s experiences of themself and others.

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Using the ACT Matrix to Facilitate Flexible Perspective-Taking In the following dialogue, Nakisha is a forty-three-year-old mother of four whose youngest son is autistic. Nakisha has just balked at doing ABA with the RBT because she is “just a mom.” She understands the need for ABA but thinks that ABA is for someone who is a behaviorist, not for moms. As before, in this example, Nakisha has been exposed to the matrix by Carmel, the BCBA working with Nakisha and her son, Noble. This dialogue represents a preliminary tap into the area of assessing Nakisha’s perspective-taking repertoire, not an intervention. Carmel:

You know, Nakisha, I hope it’s okay with you that I pull out my whiteboard and draw a matrix with you. I think it will help as we work through some of these issues.

Nakisha:

That’s perfectly okay; thank you for asking first.

Carmel:

Nakisha, I want to zoom out a bit and ask you to tell me how you see Noble and yourself today.

Nakisha:

That’s easy. He’s a child and he’s autistic. He’s okay, though; he’s lovable. And me? Like I said, I’m a mom. Moms do mom stuff. We give our kids love and affection. We put food on the table. I know you want me to do ABA, but what you do in ABA is too harsh for a mom.

Carmel:

That’s very clear. I appreciate your being honest with me. In particular, I get how you view specific things moms are about, like giving affection and fulfilling basic needs. That leads me to my next question. Do you see all this being the same or different ten years from now?

Nakisha:

Totally different, as long as you’re successful at ABA with Noble. He’ll be a teenager and have friends, maybe he’ll be a chess star—he likes chess.

Carmel:

Got it. So now I want to ask you, if I were a fly on the wall and you were doing all the things needed for you and Noble to be there in ten years, what am I seeing you do?

Nakisha:

That’s tricky of you. Because I still think the behaviorists are supposed to be doing the ABA, not moms. I got three other kids to take care of, too. I don’t have time to do all that stuff you expect me to. So, I’m doing like I said: I’m putting food on the table, doing laundry, getting them out of bed and off to school, and giving my love to them.

Carmel:

I’m smiling, of course, because you got me. But let me ask you this: Noble gets agitated in the mornings when you try and get him up. Sometimes it’s not easy. He’s put a lot of holes in the walls here. So, my question to you is, what are you doing in

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these situations that doesn’t work too well? I mean, affection and love work sometimes. But when they don’t, what are you doing? Nakisha:

Man. Okay, that’s hard. You know, I’m not always on top of my game. Sometimes I just leave the room. Because I’m not a person who can stomach all that physical violence. If I have to, I just keep him home with me. He misses school, and I know that’s bad, but I don’t think it would be good for him to go in when he’s agitated like that either.

Carmel:

That’s honest. Thank you for being so honest with me, Nakisha. Now, last question. What’s going on inside your mind as you leave the room and Noble’s hitting his head against the wall? What are you thinking to yourself?

Nakisha:

I’m thinking I’m not equipped to handle all that. I mean, I’m not giving him up or anything, don’t get me wrong. But I’m not an orderly. I can’t put my son in restraints. In these situations, he’s just who he is, you know? He doesn’t know better. I don’t even know how I feel when it’s happening. And you know what? When the neighbors start pounding on the wall back at us, I just lose it. Who do they think they are acting all righteous with me? You know what I’m saying?

Carmel:

I do. I get it. You think you’re being judged by them.

Nakisha:

And by you! I mean, not you maybe, but the RBTs you got coming into my home. I don’t even know what they’re thinking.

Carmel:

What’s that like for you?

Nakisha:

It’s like somebody’s put me in the washing machine and turned it on. I’m spinning in circles. But you know what? This has been going on for three years now, so I’m used to it. I’ve never been able to do anything when I start feeling like I’m spinning in circles, so I think that’s just how he is, and that’s just how I am. But I know it’s going to get better, so I’m just hanging on for the ride.

Carmel worked her way around the whole matrix in this exercise, beginning with values and values-based action, moving to interfering overt behavior and then the covert responses that occur simultaneously with Nakisha’s less productive actions. Nakisha’s statements about herself, her son, and the behaviorists who work with them show little derivation; it seems she has held these ideas for a long time. There is a high degree of problematic coherence to her concepts of what a behaviorist, mom, and child are—this seems to be interfering with any efforts Carmel and the RBTs are making in asking her to get involved in ABA. Interestingly, there is little complexity to this relational network; there are only a few causal and hierarchical nodes in the way she is describing herself, and that is a good thing. Regardless, Nakisha’s rela­ tional responding is entrenched, so there is indeed a lot to work on in rehearsal of relational framing.

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Looking toward an intervention, Nakisha would benefit from some assistance in tracking the relationships between her thoughts, her actions, and her son’s learning. She has a weak deictic repertoire—her insights into the way that others feel and how her behavior is increasing her son’s head-banging need intervention. Her self-concept is limited to that of being a loving mom, which is, of course, an important selfing repertoire to maintain, but it would be beneficial for her and Noble if Nakisha were to begin also seeing herself as a teacher or contingency manager. It is not necessary in all cases for someone to have insight into who they “are” before changing their behavior. However, in interlocked behavioral contingencies and negative rein­ forcement loops like the one in which Nakisha and Noble are spinning, deictic framing of self and others facilitates action that would otherwise seem dependent upon others. By focusing on this target, Carmel could help Nakisha become more response-able, or able to respond effec­ tively. In other words, she is not to blame for her son’s condition, but she is able to assist him when it does take him time to learn. But by taking action related to seeing him become a chess star with friends by the time he is a teenager, she is taking responsibility regardless of what Noble or others in his life do in the meantime. In the next section, watch as Carmel promotes Nakisha’s use of ABA by employing the washing machine metaphor to promote deictic response-ability, or ability to respond, and an expanded sense of self.

Building Exercises to Facilitate Flexible Perspective-Taking As you have been seen in previous chapters, practitioners using ACT listen carefully for meta­ phors that clients use and help them to physicalize these metaphors. This sets the occasion for inviting clients to engage in ongoing home practice of process and context exercises.

Using Metaphors to Engage Others with Flexible Perspective-Taking The following dialogue continues where the previous one left off. Carmel:

That is a fabulous metaphor; I really like that. Let’s play with that. You feel like you’re in a washing machine twirling in circles. And his head-banging is increasing, so probably it’s like someone just pressed a button, making the machine spin faster.

Nakisha:

That’s true. It does seem like that.

Carmel:

And what have you been doing to slow or stop the machine from spinning you around like that?

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Nakisha:

Honestly, nothing. I’m just hanging on for the ride. I don’t know why you think otherwise, but the way I see it, you’re the behaviorist, so you should be making this stop. No offense, but that’s how I see things.

Carmel:

You know, Nakisha, the one thing I don’t ever want you to think is that I want you to stop being a mom. You’re that boy’s mom and that’s not going to change. You go on giving him all the love.

Nakisha:

Thank you; I appreciate you saying that.

Carmel:

I am wondering, though, if maybe you might be a mom and also be Noble’s teacher. You know, that boy needs all the help he can get. Especially at those times we’re not around to help you, like in the mornings? Could you be the mom and a teacher is all I’m asking.

Nakisha:

I really don’t know about that.

Carmel:

Because all that spinning you’re doing, that can’t be good for you. And I know you know it’s not good for Noble either. As you pointed out, it’s been three years that the two of you have been on this spin cycle.

Nakisha:

I’m just waiting on you to figure out what’s wrong with him so he can do better.

Carmel:

I get it. I have an idea.

Physicalized Metaphor: Twirling in the Washing Machine Carmel could use a closed-eyes exercise, but here she capitalizes on the vibrant washing machine metaphor to generate deictic response-ability and to promote the possibility that Nakisha can be more than one self. Carmel:

Would you be willing to do something a bit unusual with me, Nakisha? Something that’s maybe, well, a little weird?

Nakisha:

I’m sure I don’t like the sound of this.

Carmel:

The thing I’m going to ask you to do is to stand up with me and come over here to the middle of the room so we can move around a bit.

Nakisha:

Okay…

Carmel:

And I want to ask you now to take this whiteboard into your left hand and the pen in your right.

Nakisha:

So far, this is not very unusual.

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Carmel:

Maybe not. But now, if you’re willing, I’m going to press the button and begin the wash cycle and I’d like you to start twirling in the washing machine.

Nakisha:

Oh, I’m sure I don’t like this.

Carmel:

I can imagine. Keep spinning. Around you go. This is what your life is like, Nakisha. Someone’s turned on the washing machine and dumped you inside. You’re stuck in there, whether you like it or not. You have no control over the spinning of the machine.

Nakisha:

You’re saying this is what it is for me to have a child with autism; I’m not to blame, but here I am.

Carmel:

Exactly. Here you are. It’s been a three-year spin cycle with no end in sight. And what you’ve been doing is hanging on for the ride. Don’t stop now—keep spinning.

Nakisha:

I don’t know what you’re thinking to do in this.

Carmel:

It’s really interesting that you say that, Nakisha. You don’t know what I’m thinking, do you?

Nakisha:

No, I don’t.

Carmel:

Well, I’m over here, and when Noble’s with me, I’m doing ABA with him. The thing is, I only get ten hours a week with him. He sleeps eight hours a night and goes to school four hours a day, so that means you’re with him 102 hours out of 168 hours a week. If my math is right, this washing machine is spinning you around 60 percent of your life each week. On top of that, think about this. That’s 60 percent of Noble’s life each week during which he and you are spinning inside this washing machine. Don’t stop—the machine is still on and you’re just holding on. What do you notice about your experience now, Nakisha?

Nakisha:

I’m dizzy and I want to sit down.

Carmel:

I hear you. And that’s really not an option, is it? At least you said you aren’t about to give Noble up, so as long as he’s with you, here you are. This is your life, right here, at this point in time.

Nakisha:

Okay, I get it.

Carmel:

Do you? I mean, first off, is it always like this or just sometimes?

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Nakisha:

Well, I guess maybe just sometimes. I mean, there are good days and bad days, right?

Carmel:

Good. So, you can stop spinning for a moment. You can even sit down for a moment if you want.

Nakisha:

Phew.

Carmel:

But what are you going to do now?

Nakisha:

Rest, I guess.

Carmel:

Okay, great. You’ve rested and used your time to chill. And now it’s time to get Noble up for school.

Nakisha:

I know where this is headed.

Carmel:

Stand up again and start spinning. What are you gonna do?

Nakisha:

Hang on for dear life because I’m his mom.

Carmel:

Okay, then. You used your downtime to relax and you’re using this time now to give Noble affection. The head-banging is increasing, Nakisha. He’s going to put a hole in the wall because that’s who he is. The neighbors are going to complain. You don’t have any idea why they would; I mean, they know Noble’s got special needs. But they do, and now let me ask you again. What are you gonna do?

Nakisha:

I’m just a mom, Carmel. I can’t be what you are.

Carmel:

No, you can’t. Only I can be who I am. But look down at your hands. What do you have in your arms?

Nakisha:

The whiteboard.

Carmel:

Exactly. What can you do with the whiteboard? Don’t stop spinning.

Nakisha:

[Pauses] Can I write on it?

Carmel:

What are you going to write?

Nakisha:

“HELP!”

Carmel:

There’s no one here to help 60 percent of the time. Just you and Noble. Your other kids are all grown up.

Nakisha:

You’re saying I can write something like what to do with Noble.

Carmel:

I’m asking you.

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Nakisha:

What if I were to try to be that thing. What did you call it? A contingency manager?

Carmel:

What would that look like?

Nakisha:

That would be me making plans for what I’m going to do when Noble refuses to get up in the morning.

Carmel:

You have no idea how proud I am of you. That sounds really good, Nakisha. Really good.

Nakisha:

If I give your ABA routine a try, can I call you to let you know how I did?

Carmel:

That won’t be the end of this spin cycle. But if you’re taking action and letting yourself be a teacher on top of being a mom, things are going to change.

Nakisha:

I think maybe Noble won’t like this. But it might be good for both of us.

Next, Carmel is going to request that Nakisha take data on days that she plans and exe­ cutes an ABA intervention with her son. Importantly, physicalizing the washing machine meta­ phor that Nakisha used helped by exposing Nakisha to the unworkability of her current selfing and action repertoires. She began to observe the futility of hanging on and became willing to be a contingency manager for her child.

Core Competency Practice As in the previous chapters, this section contains a brief description of a clinical situation fol­ lowed by dialogue that ends with a client statement. After that are questions that offer you practice at writing out fitting responses that reflect the competency and rationales for your answers. In these exercises, maintain a focus on the repertoire at hand (in the current chapter: flexible perspective-taking) in order to build skills sequentially. At the end of the chapter, look for the model responses and compare them to your responses. There are limitless ways to approach these issues; no one way is right or best.

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COMPETENCY 21: The BCBA uses metaphors and exercises to help clients distinguish between the content of their perspective and the ongoing action of taking perspective. The aim is to foster a sense of self as the field on which one performs roles, acts, and experiences life. CLINICAL SITUATION: Daniel is a twenty-one-year-old RBT with a year of college and a young son with autism he raises by himself. He spent a year in the Congo with the Peace Corps. Daniel has felt bitter after his partner left him and his child. He believes he and his child with special needs did not deserve to be abandoned. However, at the same time, he shames himself for having lost his partner and for making parenting mistakes with his own son. His threshold of tolerance for parents of kids with autism failing to follow ABA protocols is very low. Parents who work and do not come home to conduct ABA with their kids are no exception; his perspective is that everyone is responsible, and the kids need all hands on deck. A few parents have commented that Daniel is remarkably hard on them. He is great with their children, so no one has asked to have him removed from their cases. However, the BCBA Daniel reports to is concerned that Daniel is going to say the wrong thing to a parent. Mainstream organizational behavior management strategies have not produced any lasting change in Daniel’s behavior toward parents and the BCBA is beginning to see Daniel’s perspective-taking of self and others as verbal behavior impediments. The BCBA sets up an exercise in which Daniel is asked to see himself with a mom but from a helicopter a hundred feet in the sky. Daniel:

She’s being evasive. I don’t what else to do but call her out.

1. Write what your response would be. Your emphasis should be on competency 21. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 22: The BCBA uses metaphors and exercises to reduce clients’ attachment to conceptualized self or conceptualized others that create problematic rigidity or interfere with flexible responding. CLINICAL SITUATION: The dialogue continues where the dialogue for competency 21 left off but occurs later in the session. BCBA:

I like the way you’ve noted that our kids in this program need “all hands on deck.”

Daniel:

These kids—they’re everyone’s kids. They need their parents, not just us.

1. Write what your response would be. Your emphasis should be on competency 22. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

COMPETENCY 23: The BCBA helps clients contact an expansive and interconnected sense of self through building a sense of being part of a larger whole that extends across time, place, and person, whether that be a group, humanity as a whole, or the continuity of consciousness itself. CLINICAL SITUATION: The dialogue continues where the dialogue for competency 22 left off but occurs later in the session. Daniel:

Not that it’s any of your business, but I had a pretty intense go of it in the Congo; I’ve told you about that before. And I’m a single parent. So I do know what rough terrain is like in being a parent.

1. Write what your response would be. Your emphasis should be on competency 23. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 24: The BCBA uses metaphors and experiential exercises to help the client uncouple from their rigid verbal evaluations. CLINICAL SITUATION: The dialogue continues where the dialogue for competency 23 left off but occurs later in the session. Daniel:

These parents are the worst part of my job. I figured that when you hired me and it’s a prophecy fulfilled. Just like my ex.

1. Write what your response would be. Your emphasis should be on competency 24. Specifically, your response should focus on increasing novel derivations and undermining coherence. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. 3. Now write a response that focuses on improving deictic relational responding. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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Core Competency Model Responses Additional model responses are available at http://www.newharbinger.com/45816. COMPETENCY 21: The BCBA uses metaphors and exercises to help clients distinguish between the content of their perspective and the ongoing action of taking perspective. The aim is to foster a sense of self as the field on which one performs roles, acts, and experiences life. Model Response 21a BCBA:

The way you say that sounds inevitable, as though you’re an officer on a Peace Corps mission witnessing a crime. Almost as though you have to respond with force. And yet if you think about it, is this really that? Is there some kind of wrongdoing in progress here? If you were to pause and step back from the action, what else might you see in this parent’s engagement with their child?

Explanation: This is a bold move for the BCBA to make because Daniel was a Peace Corps volunteer who

had difficult experiences in the Congo. It is entirely within the BCBA’s scope of practice, though, because although the analogy cuts close to the bone, the BCBA is not asking Daniel to revisit his own past. But in asking Daniel to see points of similarity and difference between these experiences, the occasion is set for Daniel to frame his role in this situation in a new way. Then, in suggesting that Daniel pause and look at the parent from a distance, he is inviting Daniel to see the field on which the drama is unfolding and the players as extensions of himself.

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COMPETENCY 22: The BCBA uses metaphors and exercises to reduce clients’ attachment to conceptualized self or conceptualized others that create problematic rigidity or interfere with flexible responding. Model Response 22a BCBA:

You’re right. The children we serve here need “all hands on deck.” They need their parents to be there for them. I’m noticing, though, that there’s something in the way you’re saying that. Would you be willing to try something? Hold up your hand. Whose hand is it that you’re waving in the air? Now, grab that hand with your other hand. Notice that you can kind of force it to do what you want. It’ll push back, but you can at least give it an order to get on deck and do what you demand. Then again, what do you notice when you let up? Does your hand stay where you pushed it, or does it spring back to doing what it was doing before? And there’s one more thing. This is your own hand that you’re fighting with. That’s hard enough. What happens when you try to force someone else’s hand?

Explanation: The BCBA is setting the stage for Daniel to observe that he is conceptualizing himself as a

commander ordering his troops on deck. He is also drawing a parallel between Daniel’s struggles with himself and his struggles with parents.

COMPETENCY 23: The BCBA helps clients contact an expansive and interconnected sense of self through building a sense of being part of a larger whole that extends across time, place, and person, whether that be a group, humanity as a whole, or the continuity of consciousness itself. Model Response 23a BCBA:

You have had those experiences. You were there in the Congo then, and the experience you had was tough. And you are a single parent now. I get the sense that the terrain you’ve traveled in your life is connected to what you are doing now when you meet with parents. If you were a behavior analyst working with yourself then and there during these difficult times in your life, what tone would you want yourself to adopt? Would you want yourself to be tough on you when making mistakes, or would you want yourself to be gentle but firm? What do you think you might see as a possible next step for you as you work with this family and train colleagues to serve these and other parents?

Explanation: The BCBA is setting the stage for Daniel to see himself in new ways and to identify ways of

interacting that might have been useful for himself when he was struggling. Additionally, the BCBA is asking Daniel to look beyond the current circumstances to see the needs of all the parents he serves and the next generation of therapists working with them.

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COMPETENCY 24: The BCBA uses metaphors and experiential exercises to help the client uncouple from their rigid verbal evaluations. Model Response 24a BCBA:

The image of a prophecy fulfilled is evocative for me. I’m noticing myself being pulled into it. And your relating of parents you work with here to your ex as both being the worst. Daniel, if I had a magic wand that I could pass over your shoulder and change you so that you were never attracted to working here and therefore never had to offer guidance to parents, would you let me pass that wand over you?

Daniel:

No, I don’t think so. I love the kids and what I do with them too much to let it all go.

BCBA:

That’s a cool insight. Now imagine that you’re a prophet. A modern-day prophet looking at yourself in the future from the vantage of what we just discussed today. Given how much you love the kids and your work with them, is there any chance you might look into the future and see a new possibility in yourself and the parents we serve in the days to come?

Explanation: The BCBA is working to foster a new derived relation—that Daniel is willing to work with dif-

ficult parents because it is part of serving the kids he loves. This calls into question the ongoing coherence of the prophecy he made and sets the occasion for Daniel seeing himself and, even more importantly, the parents he works with from a new angle, perhaps compassion for them and for himself.

CHAPTER 12

Valuing

If you could give a single gift to every client, parent, and staff person you have ever worked with, what would it be? Watch what happens in your mind as you contemplate this question. Do you see the options whirling before your eyes? The way the calculus of good things you might offer shifts as the area under the curve of reason and control that dominates your every­ day thinking expands? Perhaps it is a book, a work of art, a poem, or a prayer you would share. Are you drawn to offering hope, to sharing power, to paving the way to purposeful action? Do you aspire to alleviate their suffering? To vanquishing their fear? Would you share a map and compass to guide their efforts at moving in a direction their hearts are longing for? And now, for a moment, turn your attention to yourself. Here you are, coming toward the end of this book, a behavior analyst standing on quivering beginner’s legs that are setting out to use ACT in your practice, daring to do something bold and new, frightened that you might not know what you are doing, terrified of making a mistake that would put you before an ethics review board, and yet here you are, determined to be the difference in others’ lives… If you could give a single gift to yourself, what would it be? Please do not be too quick to answer. Let the question move you slowly.

 The first time I asked these questions to leaders in the boardroom of a human services agency, one person’s eyes welled up with tears and they let out a gasp. We discussed it, and they shared that the exercise spotlighted a gap between what they wanted to be about in their life and what they were doing. I was not prepared for the amount of emotion that showed up throughout the room. It was all I could do to sit with them and bear witness. Over the years since then, I have asked these and similar questions to countless parents, teachers, paraprofessionals, behavior analysts, and other human service workers. Each time, the air in the room gets heavy. Each time, a roaring silence enters and overtakes the room. Each time, this question leads to a sense that there is more to life than being a frightened bystander to one’s own life.

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Nothing defines ACT more than this crucial question. Although other behavioral approaches today focus on valuing, ACT delivers its heart in the context of inquiry into the dominance of logic, the avoidance of challenging emotion, the unbearable discomfort of being present, and the calcified dryness of a self that says it cannot change. That makes this question more than just one of six repertoires to be taught. It is both the foundation and the capstone. It is the daggerboard of the boat on which you sail your behavior analytic career and your life. That is why I ask that you sit with the question and let it move you slowly. When a wind catches the sail, this daggerboard will keep you moving in a direction of purpose that you cherish.

The Importance of Valuing B. F. Skinner wrote voluminously about valuing. He taught behavior analysts to value parsi­ mony, skepticism, empiricism, and experimentation, among other things. Skinner’s ultimate value was survival of the species and our planet, which seemed on the edge of destruction for the first time in history during his life span. Skinner’s aim was the development of a compre­ hensive science of human behavior, inclusive of all things that humans do (1953). In this tradi­ tion, applied behavior analysts have sought effective and efficient interventions to help people contact reinforcement and gain access to reinforcing environments. But verbally able humans come to ABA with a rich history of social, political, economic, ethnic, and spiritual education that is important to them. That these variables are difficult for behavior analysts to measure does not mean they should be unimportant to us. They are the wellspring of meaning that clients can identify in our presence and that we can help them orient their actions toward in a way that is congruent with the rest of their lives. If Skinner’s work was about anything, it was about this—capturing what it means to be alive and whole, a whole being nested in a time and place and part of something bigger that influences and can be influenced. By orienting toward what matters, what you yearn for in your work as a behavior analyst, you can stay your course or change it in ways that are likely to contact deep pools of positive reinforcement even when the going is rough. Skinner recognized the challenges in this. So did Hayes, Strosahl, and Wilson (1999) and many others who shaped the themes and practices of ACT. Though huge, the challenges are not insurmountable. In fact, they can be difficult but also fun and even lighthearted to sail through. This chapter offers tools for navigating your practice with the compass of your heart and guiding your clients to do the same. That brings up an important question for the field of ABA: who determines what is socially significant, the therapist or the client? In ACT, and most powerfully in the stuff of values work, you are not the captain of your client’s boat. They are. You are there to help them slide the dag­ gerboard into place so that they move in a direction that matters to them.

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Functional Assessment of Valuing Deficits Although Skinner suggested that survival is what human valuing ought to be oriented toward, he somewhat surprisingly never operationally defined values, per se. In 2005, Dahl, Wilson, Luciano, and Hayes offered this definition: values are “verbally constructed, global, desired, and chosen life directions” (p. 61). This takes valuing to a very different level than Skinner had, though there is a very important connection, as will be apparent. Identifying what matters to learners who have not yet begun to speak does not require a definition such as this. Developmentally younger learners with nascent verbal skills can be asked questions that relate to their “life directions” but only at a very simple level. Conversations about valuing with these clients must be skillfully adapted to their developmental needs. Perhaps the earliest of these conversations can be focused on preferences for activity, touch, food, and so forth. Later, the dialogue can be turned toward an inquiry about what other people prefer. From there, it is possible to ask what things are important to a dyad or small group that the learner is a part of. Increasingly larger circles of people, animals, and environment can come into these conversations over time along with questions pertaining to when, where, and why these things might matter. Although abstract, this is where the connection with Skinner’s valuing of survival fits. Even young children can be taught to ask the circumstances under which they might be willing to give up one of life’s pleasures if it would mean that others would have a better chance of surviving. Noncoercive, inquisitive inquiries into the possibility of agape, or love of all beings, can lead to a sense of valuing that transcends oneself and those in one’s immediate surroundings. For those that engage in more complex languaging, many aspects of life are well suited to questions that link current behavior to remote outcomes. Behavior oriented to these distal, though perhaps uncertain consequences can be imbued with a rich sense of purpose and meaning. ACT values assessment turns to these questions in service of helping clients develop a process by which to make skillful choices throughout their lives. Thus, valuing is an ongoing process that goes beyond social conditioning, moral training, and ethical conduct guidelines. In moments of deep connection to values, there is a sense of being touched and clothed by inti­ mate, personal fabrics, fabrics that we ourselves selected and stepped into. As discussed in an earlier chapter, functional contextualism takes a pragmatic approach to ways of conveying complex matters in order to be of service in clinical contexts. The issue of valuing is indeed complex when viewed through a scientific lens. Most likely, what we appear to select as our values are actually culturally determined by some combination of religious, familial, political, sociological, and peer group influences. But as a matter of lived experience, we have the verbal experience of being pushed or pulled and, alternatively, freely choosing. Although it would be possible to describe this scientifically to clients, it is important to ask why, in what context, and for what purpose. In most clinical contexts, it will be much more empow­ ering and supportive to discuss valuing as a matter of free choice. Thus, technically speaking, operant behavior is probabilistically determined, and it is a complex and inconsistent mashup of

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phylogeny and ontogeny that determine what one actually does at any moment. But function­ ally speaking, because one can act in ways that contact only the smallest and most mundane of reinforcers, it is true that a person can act small, or instead, behave in ways that affirm their deepest yearnings, even when such bold actions risk being hurt. As a clinician, you must ask yourself which way of speaking would be most useful to your client. You may begin by asking which way of speaking helps you most as you wrestle with life’s pressing dilemmas. In assessing values, there are certain obvious tells, such as “I don’t know why I’m doing this anymore,” “What’s the use?” or “This whole thing is meaningless.” But other ways of perceiving that a person has lost contact with their values might be in noticing that they are unable to tact the price they are paying for being fused to overextended rules or for avoiding things that are hard in life. You may notice that they are “mind-y,” or overly intellectual when describing their thoughts and emotions. Likewise, when someone is out of touch with the costs associated with being consumed by the past or future or is unable to articulate the price of being attached to a prescribed role in life, you may assess a need to focus on values. Finally, when someone is behav­ ing in ways that are immediately pleasurable but take away from the deeper joy that comes from delaying gratification, you may consider values work to be useful. In short, each of the other five ACT repertoires are directly linked to values, and one important way to assess the need to conduct valuing exercises is to evaluate the global ways in which a client is open, aware, and active in their lives. In fact, a useful way to begin your work on these other targets is to connect the work you do there to your client’s verbal constructs regarding meaning and purpose in their lives. Numerous indirect assessments are available, but these self-report tools should be used with an understanding that they are screening instruments that may over- or underestimate behav­ iors of interest. This is true in clinical psychology work, but it is even more the case in ABA contexts where neither are you treating psychological issues, nor are such issues always heavily pronounced among those you work with. Tools developed for use with clinically depressed and anxious populations may not be sensitive to the issues faced by the “worried well” parents, staff, and kids with whom we work. More useful to ABA practice is conversation in which you gently orient attention away from ongoing problems and toward the overall significance of broader life domains, such as work, school, family, health, leisure, and spirituality. By asking whether it would be okay to shift from complaints to a dialogue about the things in these domains that one cherishes or would cherish if they could, you set the stage for more intimate values work. Once a client is invested in these conversations, there are specific things to look for. First, consider the dynamism in tone, pitch, rate of speech, and so on. When inspired with vision, this dynamic quality is present in speech. Body movements may also be animated, posture erect but relaxed, and so on. Sometimes when a person is connecting to their more intimate purposes, their voice softens, their eyes widen, and their voice volume becomes almost inaudible. These are signs that energy linked to values is in the room. In contrast, listless speech, dull and avoidant eyes, and lethargic movement may help orient you to the need to address values.

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Second, listen for dialogue that links the past to the present and the present to the future. When a person is in touch with things that are of deeper significance to them, they are grounded in the present but a connection to past events and an important future is palpable. When a cli­ ent’s verbal behavior is moored to very recent events and they are unable to see into the inevi­ table future should they continue to let important things slide, they would likely benefit from values work. Third, pay attention to the textured manner in which clients describe their chosen values. If they are freely choosing (again, this is a pragmatic way of speaking), there is often a sense of options to be considered, an appreciation of multiple available paths. Alternatively, clients may describe their values as though the options are limited, their hands are tied, or their selection is not truly their own. Next, listen for tenderness. When values are in the room, clients are willing to show their soft underbellies. They do not need to be perfect or look good. In fact, there is a willingness to admit they are in the weeds, mud, and dustbowls of the moment—in service of moving toward something precious. Without this, values conversations will occur to you as posturing. A person may say the thing they think you want to hear and appear to be in it for all the right reasons, but in the spaces between their words you might hear it—a tone of resignation, defeat. A space of destitution. When you hear this, there is work to be done. Finally, listen for the link to overt behavior. ABA work in the space of values demands a very direct refocusing toward goals that can be accomplished in the short and long term through concerted action. When values are overly abstract, there is no magnet coupling them to observ­ able, measurable behavior. The tells for this are subtle, but you can sense it in overly intellectual speech about high ideals. Statements like this are not values, in the sense that they are not connected to ongoing patterns of behavior that contacts increasingly powerful reinforcers over time. It is almost as though the work that is to be done is for someone else to accomplish. In contrast, valuing is getting ready and then doing the deeds that make life better. When these actions are nowhere in sight, there is more values work to be done.

The General Approach to Treating Loss of Contact with Values Earlier in the chapter, I described a time when, after a values exercise, one of the leaders of an organization I consulted with broke into tears. Something else that is worth discussing here happened after that. The owner of the company folded their arms and decided that they would not be letting BCBAs conduct any ACT work with clients or parents after that. They sensed the risk of overreach, the possibility that values conversations would turn into talk therapy or subtle but damaging coercion. Fortunately, their willingness to train ABA professionals in ACT returned, but the dangers they described are real. As has been discussed many times in this volume, ABA practitioners focus on socially important, observable, and measurable behaviors. Valuing is not directly measurable or

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observable. Although it is possible to quantify verbal behavior about values, these are not values per se. Nor are changes in voice volume, cadence, pitch, or other elements of body language. All of these measures are indices of something, but what that something is may or may not be values. Thus, it is important to approach functional assessment of this and all other ACT targets with humility. With values, though, it is especially important to transition to committed action. It is not by accident that in the ACT hexagon diagram, values and action are on the same pillar. As a general approach, when opening up values, tether them to committed action that can be observed and measured. Perhaps this is true of the aims of ACT across all helping professions, but it is especially important in ABA. Our right to practice is bound with our con­ tinued vigilance in this regard. The importance of this cannot be overstated. I will say more on this in the chapter on scope of practice at the end of this volume.

Using the ACT Matrix to Facilitate Valuing An entire quadrant of the matrix is devoted to values. It seems at once too little in light of all that has been said so far in terms of the six ACT repertoires and too much in light of all the other ACT repertoires to be addressed. Still, the matrix does a good job at helping uncover important indirect-acting variables. The values quadrant (lower right in the traditional version, upper right in the “walking person” version of the matrix in which the head is high and the feet are low) can be completed in a single session, or it can be completed over many sessions in which the conversation deepens and extends to different life domains. In a typical ABA session, the skilled therapist is not asking anyone to speak broadly about what matters to them. Instead, more typically, ABA ACT sessions pertain to an overt behavior that has been excessive or deficient. Thus, appropriate values quadrant questions pertain to the domain of life in which the target behavior falls. For example, a target behavior of initiating social interactions during lunch at school might fall into the domain of social friendship. Thus, an appropriate valuing question to help with this might be, “What is it about having friends at school that is meaningful to you?” Or, if the target behavior is decreasing the use of coercion when asking a child to do chores at home, a parent may be asked, “Talk about the quality of relationship that you long to have with your child.” These questions open the door to exercises in which the past and present are connected to a vital, if remote, future. Fortunately for ABA practitioners, the matrix also facilitates moving the discussion to overt behavior. But it is from the figurative and metaphorical constructions embedded in a client’s speech that the actual exercises promoted by the matrix will emerge. An important skill to master is the shaping of values statements. Often, when asked ques­ tions such as “What is it about having friends at school that is important to you?” the answer is quantitative rather than qualitative. “I want to have lots of friends” or “That means I’m popular” or “Then I’ll get lots of ‘Likes’ on Facebook” are common answers. The question is the right question, but the answers that are evoked may not be useful.

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To shape these kinds of answers into useful values statement, try asking follow-up questions that target a quality of being. From there, you can shift to important qualities of action and then specific, measurable behavior. For example, “If you had lots of friends, what kind of friend would you try to be?” helps move from quantity to quality. Or “If you were popular, what do you think people would say they liked about you?” Although Facebook friendships are tricky, if the topic of friendship goes there, one way to shape useful dialogue is to talk about the general way that people popular on Facebook act. For example, “Who do you look up to among the people you like on Facebook? What is it about them that you admire?”

Building Exercises to Facilitate Valuing As you’ve seen in previous chapters, after identifying an ACT repertoire in need of treatment, one strategy is to evoke a metaphor that you will use to build the intervention. Unfortunately, not all clients use metaphors when you fish for them. You may need to bait the hook, so to speak, to help a client develop a metaphor. In the following segment, you’ll see Maya help Randall generate a metaphor to be used in an ensuing eyes closed exercise.

Using Metaphors to Engage Others in Valuing Consider Randall, a thirteen-year-old boy with autism who asks Cheryl, a girl in his class at school, out on a date four times. Each time Randall asks, Cheryl declines. His questions have become more insistent, and Cheryl told a school guidance counselor. Maya is a BCBA working with Randall. Maya:

You told me that you are lonely, Randall, and I certainly appreciate you sharing that. You said that you want to have a girlfriend. When I asked what you would be like as a boyfriend, you said something beautiful. You said that being lovable is important to you.

Randall:

Because being lovable means you’ll be loved.

Maya:

Very possibly. And you can be loved in many different ways. You can be loved as a friend, as a son, as a nice person, and of course, as a boyfriend.

Randall:

I want to be a boyfriend. I want to be Cheryl’s boyfriend.

Maya:

I do hear you. You want to be a boyfriend. I want to ask your permission. Let’s come back to that desire in a bit. Your desires are important, but your life is even more important than your problems. Is it okay if we zoom out a bit and talk about that?

Randall:

Okay, because I want to have a girlfriend. That’s important to me.

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Maya:

Okay, so we are going to take this camera and zoom way out. It’s a really wide-angle lens that helps us look from the future.

Randall:

That’s cool!

Maya:

Now looking from the future, let’s say from next year, you can look back on today, tomorrow, and even next month. You with me?

Randall:

I like this camera.

Maya:

It’s cool, huh? Now let’s use it to look into the past for a moment. Who’s someone at school that was a really good friend to you last year?

Randall:

James is my best friend. He’s cool. He was my best friend last year, too.

Maya:

Awesome. What is it like when you’re around him?

Randall:

Well, he’s funny, so it’s fun to be with him.

Maya:

Nice. He’s funny. He’s fun to be around. What do you think he’d say about you?

Randall:

James would say I’m really nice and I’m smart.

Maya:

Now we’re getting somewhere. Which of those are lovable ways of being, do you think?

Randall:

Um, maybe being nice is lovable.

Maya:

Now let’s zoom this camera in close. When you’re being nice, do you think it’s cold around you or is it warm?

Randall:

If I’m being lovable? Warm, I guess?

Maya:

And are you being smooth like butter or rough like sandpaper?

Randall:

Smooooooth!

Maya:

Great. Now let’s zoom this camera into the future. Sometime in the future you might get to know someone new, a girl you want to get to know. You might try and get to know her before you ask her out. In the meantime, you’ll have an opportunity for her to get to know you. You’ll want to be lovable, sure. But what would that be like?

Randall:

Oh! I think I get it. I like it when James is funny, so I might try to be fun to be around. And James likes it when I’m warm and smooth. Is that what you mean?

Maya:

That’s exactly what I mean. Smooth as what, do you think?

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Randall:

I don’t know. I don’t even know what you mean.

Maya:

Well, if you’re smooth, is it smooth as silk, as butter, as…

Randall:

Smooth as…I don’t know. Maybe flour.

Maya:

Flour?

Randall:

Like when you dip your fingers into flour, it feels really smooth.

Maya:

You’re really good at this, Randall. And if you were being funny, funny as what?

Randall:

Funny as…as a puppy trying to run!

Maya:

Brilliant. How about this. If you were also being warm, warm as what?

Randall:

I got it. Warm as maple syrup when you heat it on the stove.

In this exchange, Maya has set the occasion for more intricate exercises in which Randall can practice being warm, funny, and smooth. The metaphor of a camera zooming in and out was something she came up with, but it worked, and it set the stage for Randall to use meta­ phorical language. In the next section, watch as Maya builds an exercise around one of the metaphors that Randall created.

Eyes Closed Exercise: Warm Maple Syrup In this exchange, Maya asks Randall to close his eyes to help him imagine states of being that are different from what he is currently experiencing. Maya:

So, funny as a puppy trying to run, smooth as flour on your finger, and warm as heated maple syrup. That’s being lovable, for you. I’ll bet many people would find these qualities lovable. Now I have a few questions for you about this, Randall. Would you be willing to close your eyes with me for a moment? I want you to get comfortable and notice everything that you can smell in this room right now. It’s kind of a funny smell, since we had lunch a little while ago, right? Now, let’s pretend we hadn’t had lunch. Let’s pretend it’s going on four hours since you’ve eaten anything. And now I’m making pancakes and warming up some maple syrup. Can you smell the maple syrup?

Randall:

Smells delicious.

Maya:

To me, too. Right now, in this situation, you like maple syrup. It’s something that would add to your experience of pancakes.

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Now let’s fast-forward. You’ve just eaten two stacks of pancakes with syrup. It tasted marvelous, and now you’re full. You are totally full! And now I offer you some more maple syrup. Just maple syrup. Is this something you care for right now? Randall:

I don’t think so.

Maya:

I’m asking because I’m wondering. Maybe it’s like that with people, too. Can I bring up something a little hard?

Randall:

Okay.

Maya:

You’ve asked Cheryl out a few times now. She hasn’t said yes. I wonder if maybe you’re warm like maple syrup, but she’s not interested in maple syrup right now. You want to be lovable like warm maple syrup. That’s a sweet way to be, Randall. I’ll bet there are many people who would like to be with someone like you, someone who cares enough about them to be warm around them.

Randall:

You think?

Maya:

Yes, I do. And I think many people would like someone who is funny like a puppy running and smooth like flour, too. And you know what else, Randall? I wonder if you might just care about being this way with people you like enough to let Cheryl be. In the meantime, you might try being these ways, these very important qualities of who you are, with other people. What do you think might happen if you let other people see these qualities in you?

Randall:

Who should I talk to?

Maya:

That’s a great question, Randall. Try talking to lots of people and see who likes those things about you that are lovable.

As noted earlier, values conversations can be tailored to the developmental needs of the learner. In this case, Randall needed a little help in identifying the qualities of being he thought might be important in a partner. Next, Maya helped Randall begin to see that Cheryl was only one person and that by identifying what he wanted to be about in a relationship, he could more easily find someone who likes him for what he finds important in himself. An important aspect to note about this interaction is that Maya did not ask Randall to identify what he wanted to get in a relationship. That might be important, too, and something worth following up on later. But a starting point for Randall was to point himself in a direction of travel that he wanted to be about. In this way, the dialogue answers a question posed by Wilson and Murrell (2004), “In a world where you could choose to have your life be about something, what would you choose?” (p. 135).

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Core Competency Practice As in the previous chapters, this section contains a brief description of a clinical situation fol­ lowed by dialogue that ends with a client statement. After that are questions that offer you practice at writing out fitting responses that reflect the competency and rationales for your answers. In these exercises, maintain a focus on the repertoire at hand (in the current chapter: valuing) in order to build skills sequentially. At the end of the chapter, look for the model responses and compare them to your responses. There are limitless ways to approach these issues; no one way is right or best. COMPETENCY 25: The BCBA helps the client clarify values-based life directions related to overt behavior slated for change. CLINICAL SITUATION: Brené is a thirty-four-year-old French American mother of Blaise, a six-yearold boy with autism and multiple medical needs. Her partner, Frank, works two jobs to support the family while Brené takes care of Blaise full time. Brené admits that after her child was born, she mostly put her life “on hold,” and after Blaise was diagnosed with autism, she completely stopped living her own life. BCBA:

If there was something you could add to your life right now that would give it meaning, what would that be?

Brené:

I just don’t know.

1. Write what your response would be. Your emphasis should be on competency 25. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 26: The BCBA helps clients commit to what they want their life to stand for and focuses the therapy on this process. CLINICAL SITUATION: The dialogue continues where the dialogue for competency 25 left off but occurs later in the session. BCBA:

You’ve discussed feeling very sad and unfulfilled because you don’t have a life. You also talked about the need to build some valued activities back into your days— things like tango dancing and running, which were very important to you just a few years ago, before Blaise was born. Now I hope it’s okay if I challenge you a bit. Because Blaise sees how you are living your life, and if he grows as we both aim for him to grow, he will care about his parents. He may feel sorry for them if they are sad and unfulfilled. He may emulate them. Right now, your life is about taking care of Blaise. You’ve mentioned that you completely stopped living your own life. If you could make your life be a life of your own that Blaise could see and emulate, would you being willing to take a stand—for your life?

Brené:

I don’t know. It’s really been too long and I’m too out of shape for those things now. I don’t know.

1. Write what your response would be. Your emphasis should be on competency 26. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 27: The BCBA teaches the client to distinguish between values and goals. CLINICAL SITUATION: The dialogue continues where the dialogue for competency 26 left off but occurs later in the session. BCBA:

I’m proud of you. You’ve identified some very important values-based activities and set goals for getting back into them. Now it’s time to step back and think about what it is about these activities that are meaningful to you.

Brené:

Well, I don’t want to overthink it. I think these are my values.

1. Write what your response would be. Your emphasis should be on competency 27. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

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COMPETENCY 28: The BCBA distinguishes between outcomes achieved and involvement in the process of living. CLINICAL SITUATION: The dialogue continues where the dialogue for competency 27 left off but occurs later in the session. BCBA:

You’ve done great so far. You’ve clearly identified values-based activities and gotten closer to clarifying what you want your life to be about. You also mentioned that you were a competition dancer and runner, and that winning has always been a thrill for you. I’m guessing that if a month from now you were heavily invested in competition tangos and 10K races, you might see the purpose of all this as being related to scoring high and winning. And given that your life is very different now than it was before Blaise was born, I’m wondering whether the purpose of running and dancing would be the same today or whether it might have changed?

Brené:

I’m out of shape but if I commit a lot of time to it, I’m sure I could be competitive again. Winning was a thrill. But it took pretty much all my time and energy. So maybe you’re talking me out of it. I don’t think I do want to run and dance anymore.

1. Write what your response would be. Your emphasis should be on competency 28. 2. Describe the function you are inferring from the passage above and how you aim to address it. Remember that based on a few words uttered in a verbal exchange, you are only hypothesizing the function. Further work you do will flesh out whether this is accurate, incomplete, or off the mark. Note: After writing your response, check it against the models at the end of the chapter before going on to the next exercise.

COMPETENCY 29: The BCBA states their own values and models their importance. 1. Write three sentences that describe your own values related to the discussion thus far with Brené.

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Core Competency Model Responses COMPETENCY 25: The BCBA helps the client clarify values-based life directions related to overt behavior slated for change. Model Response 25a BCBA:

Maybe the way to look at it is that Blaise will benefit from seeing you put something into your life that generates a sense of purpose and vitality. He’ll be empowered seeing you empowered. Would you be willing to write a few thoughts down on paper about qualities you might add to your life that would bring a sense of purpose and dynamism?

Explanation: The BCBA is aware that at the moment, Blaise is everything to Brené, so in a way, it is wise

to begin there. Later, the BCBA will also model stating and living into values. Offering to do this and asking Brené to do this for her son is on par with the ACT stance that we are all merely fellow travelers.

COMPETENCY 26: The BCBA helps clients commit to what they want their life to stand for and focuses the therapy on this process. Model Response 26a BCBA:

I get it. Being out of shape is hard when in the past you were strong. You know, Blaise looks up to Batman. Batman was a ninety-eight-pound weakling before transforming himself into a superhero. And he had a bunch of botched early efforts at crime fighting before fully emerging as the Dark Knight, right? What if your life was not even about being a superhero, but about the journey back to being strong—a hero’s journey, if you will?

Explanation: This move again links the development of a sense of Brené’s purpose to things that would be

meaningful to her son, but there is a neat twist here in that the BCBA is pointing out that standing for something is not about being perfect. The implication is that taking a stand in life does not require that you look good or always get it right. It means getting active, and at first, that sometimes means falling on your face.

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COMPETENCY 27: The BCBA teaches the client to distinguish between values and goals. Model Response 27a BCBA:

Haha—yep. I appreciate not wanting to overthink things. And there’s also something important here in looking beyond the activities of tango and running. It’s possible you’ll do these things long into your seventies, maybe even your eighties. But it’s also possible that you’ll have an injury or age will creep up on you. If you think about it, what are the things about tango and running that capture you?

Brené:

Well, I don’t know. They were both competitive activities for me.

BCBA:

That’s good. That’s a start. What is it about competitive activities that is vitalizing for you? If you can identify this, then there could be other values-based activities you do beyond these two activities. You might say that running the 10K and dancing the Milonga Competition that you’ve committed to training for are two cities. They are Madrid and Paris. Maybe your value is the direction in life that passing through Madrid and Paris is taking you? What is it that these two points on the map have in common? If they are aligned in a particular direction, what direction would you say that is?

Explanation: Competitive physical activities may produce certain reinforcers that could be mirrored in

nonphysical activities. Being able to tact the broader class of reinforcers is the start of differentiating between having goals and having values. In the long run, valued activities change for most people, so generating an idea about the broader class of reinforcers helps in the selection of new activities that are equally life affirming, even if topographically distinct.

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COMPETENCY 28: The BCBA distinguishes between outcomes achieved and involvement in the process of living. Model Response 28a BCBA:

You don’t have to. That’s kind of the point. It’s not about doing a thing but living into life in a way that enriches you.

Brené:

I like that.

BCBA:

If you do not let go of the commitment you’ve made to running and dancing, you might yet consider looking at it from a different point of view. You ran and danced to win. You also had all the time in the world to train. Now, you don’t have that kind of time. But you still love the movement. What else about running and tango do you love? What is it about these things that could keep you doing them long after the competitions end and the ability to win fades?

Explanation: A theme in these last few exchanges has been generating a tact of the broader generalized

operant class of behavior into which running and tango fall. One aspect of this is competition. That is an important discrimination in itself. But due to the different circumstances that embody the experience that Brené has of being the mother of a medically fragile kiddo with autism, it is important for the BCBA here to take it one step further. If Brené can tact a texture one step higher, she will have generated a life direction that allows for pragmatic goal setting and that both supports and is supported by other flexibility repertoires.

COMPETENCY 29: The BCBA states their own values and models their importance. Given the nature of the exercise for this competency, there are no model responses.

CHAPTER 13

Committed Action

Upon receiving the International Pfeffer Peace Prize in 2014, Dr. Widad Akreyi wrote, “Peace may be hard to achieve but it is possible with small yet essential steps that are guided by courage and sufficient commitment.” These words resound as as a clarion call and bridge to the final chapters of this volume related to committed action and vigilant practice. An epidemiologist by training, Akreyi began documenting human rights abuses in Iraq early in her career after successfully standing up for female classmates subjected to abject humil­ iation in school. She went on to advocate for gender equality and women’s empowerment in the Middle East and North Africa before founding worldwide campaigns to end genocidal hate crimes perpetrated against Syrian Kurds and ethnic Yazidis in Northern Iraq. Her tireless, small advocacy actions, seemingly insignificant in themselves, grew in recognition over time and led to unprecedented regional changes in human rights policy and enforcement. Failures, missteps, self-doubt, and criticism from others have not derailed her. Concerning commitment and action, Akreyi’s resounding message is that no act is too small, no step is too fragile, no breath too faint to count in the march toward peace and justice.

 In applied behavior analysis, the rubber meets the road when a client responds to contin­ gencies of reinforcement. Some clients immediately respond to direct contingency manage­ ment strategies. With those individuals, there is little need for the paradoxical interventions described in earlier chapters. Unfortunately, practitioners often note that clients can resist interventions in ways that wall them off from the optimal pools of reinforcement waiting on the other side of what seems to them to be an impassable barrier. What is there to do to help those who employ their verbal defenses to protect against cognitive and emotional hurt? For them, the tools throughout this volume are offered as a means to loosen the glue that holds rules about self, the world, the past, the future, and pain together in a bundle. It’s a ball of confusion that contacts immediate negative reinforcement at the cost of missing out on life itself, the ultimate cache of positive reinforcers. Once softened, this ball can be peeled apart, and the analyst can return to overt behavior shaping, fading, instruction, goal setting, feedback, rehearsal, and reinforcement.

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The Importance of Committed Action It seems odd to discuss the importance of committed action with ABA practitioners. Behavior analysis arose as a counterpoint to the notion that psychological well-being is the result of intro­ spection. The radical idea that emotional health comes from putting one foot in front of the other, and that the optimal way to ensure this happens is not by lying on a therapist’s couch but by arranging schedules through which antecedent and consequent stimuli can do their magic, is, by now, old news. And this is pretty much the bulk of what we do in ABA, so what is the need to talk about its relevance here? For certain, the need to focus on this topic in this volume is less pronounced than in those aimed at training therapists outside the behavioral tradition. But for us, too, there is reason to address this topic. I have taken roughly twenty ACT workshops and offered ACT training to many hundreds of ABA practitioners over the years and one of the most interesting phenomena I have observed is the reluctance of learners to put themselves in the BCBA’s shoes when role-playing ACT repertoires. I often relish these opportunities, probably because I have some acting background. But I am not immune to the occasional desperate wish to just watch and neither make myself vulnerable as a client nor more vulnerable as the therapist bumbling and stumbling through the exercise. At these times, I am remarkably adept at convincing others to take these roles and give me the avoidance pass. It is funny, because when we are working with clients, newer staff, and parents, we encour­ age them to try and put their best foot forward. We let them know that we expect they will make mistakes and that these mistakes are useful because it is by experiencing the contingen­ cies that we learn them. But when it comes to us trying something new and challenging…well, that’s often a different story. As discussed in the very first chapter, a central pivot that ACT requires of ABA practitio­ ners is to relinquish the unexamined assumption that the therapist must be an expert, the person with a plan, the master. Learning ACT involves trying out a vastly different approach to ABA in which the therapist does not begin with a perfect plan. The more vulnerable you are in practicing new skills when first learning ACT, the more it will be like actual ACT work with ABA clients. That is, when conducting ACT with clients, you may be at your very best when you model relinquishing control, sweating, stuttering, observing yourself reflecting obsessively on past experiences of failure and perfection, and losing contact with your chosen direction. If nothing else, that ACT calls on you to show your imperfections is downright counterintuitive. Two themes emerge in the analysis of this kind of perfectionism. First, why do today what you can put off until tomorrow? Behavior analysts are no more immune to procrastination than those they serve. And it is exactly this kind of avoidance that makes connecting with emotions, disconnecting from entangled thoughts, refocusing on the present, seeing self-in-context, and identifying values important. We avoid anxiety and thoughts about the mistakes we are likely to make by avoiding the actions in which we feel and think this way.

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But there is a second theme that is equally malign in perfectionism: If I just keep doing what I’ve been doing, it will all work out. Perseverance can be productive, but it can also be a way that we avoid making changes. Compulsive perseverance can lead to workaholism and related health problems, disconnection from treasured relationships, and other social difficulties. It seems likely that, in some cases, repetitive behaviors seen in autistic people can be assessed for the extent to which they avoid the difficult thoughts and emotions that accompany task completion or social engagement. Thus, in one sense, committed action is important because it helps address these two extremes of perfectionism. Procrastination and perseverance affect us all, and ABA practitio­ ners learning ACT are no exception. Fortunately, learning to catch this in flight gives you the opportunity to be vulnerable and courageous in opening up to what you are doing with those you serve. You might begin by opening up to this when you are in workshops and called to participate in role-plays. A second aspect of committed action work is tackling delay discounting. Humans discount the value of things they have to wait or work for. We tend to cash in on the immediately avail­ able reinforcers, even if they are small compared to what we would earn through concerted effort. Committed action work is important because, like procrastination and perseverance, delay discounting can occur beneath the level of awareness. Connecting action to values is vitally important in this regard, as is identifying cognitive, emotional, temporal, and perspec­ tival muddles that impede overt behavior change. Because delay discounting and perfectionism are difficult to observe, they are common to all of us, including behavior analysts. A final reason that explicitly addressing committed action is important is a bit uncomfort­ able to say out loud. In advanced ACT for ABA workshops, I ask students to give case presenta­ tions. My explicit instructions are to provide background in the full range of direct contingency management assessment and intervention strategies that have been used. Given these instruc­ tions, it surprises me how often these get omitted. I have stated frequently in this volume that ABA ACT cannot be conducted without linkage to direct contingencies, and that when it is, practitioners give off the appearance of having slipped into cognitive counseling or talk therapy. A focus on direct contingencies and overt behavior is as important for non-ABA psycholo­ gists using ACT as it is for professional behavior analysts, but it is foundational to those of us who bill for services under the rubric of ABA. I will say more on this in the next chapter on scope of practice, but for our purposes here, it is useful to note that sometimes, you and I engage in problematic private verbal behavior about managing other people’s contingencies. It seems easily defensible with young learners, but with parents, teachers, and paraprofessionals it may feel awkward. Still, direct contingency management is what we do. Below I will offer some ways to do it that are less threatening. But as a starting point, it may be helpful to try and observe your own interfering verbal behavior about managing other people’s contingencies. In short, no one gets a pass. No one gets out of here alive. We all get stuck and avoidant. We all benefit from attention to the six ACT repertoires, including committed action.

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Functional Assessment of Committed Action Deficits Tells that should alert you to a possible need for committed action work include statements such as, “I know this isn’t helping me in the long run, but it feels good, so I’m going to keep doing it,” “I know I need to do this, but I’m exhausted, so I’ll start tomorrow,” and “Get off my back; I’m going to do it, just not now.” These statements potentially share a kind of temporal distortion. That is, there is a notable link in these statements between lack of committed action and loss of contact with the present moment. Impulsive behavior more broadly is a strong indicator that a person would benefit from linking values to action by setting clear contingencies and account­ abilities. In contrast, compulsive perseverance may be noted in statements such as “I just want to continue what I’ve been doing,” when what has been done is clearly not working. Inaction is often audible in statements such as “Let me get back to you to schedule a little later,” as a refrain for a song in which tomorrow never comes. Overly vigorous behavior that is not well connected to values and under defective stimulus control includes statements such as “I’m doing everything I can; let me tell you all the things I’m doing,” and “I gave up because I tried all the things.” Finally, “I want to do this but every time I start, the feeling of hurt and anguish overwhelms me, so I stop” is a common tell that experiential avoidance is linked tightly to unfocused action. In many of these tells, you may notice that when other ACT repertoires are stagnating, committed action is less probable. This is why direct contingency management alone is often necessary but insufficient. We engage in interfering private verbal behavior along the dimensions of the other five ACT repertoires that, if addressed, makes the management of contingencies in committed action work go more smoothly. Reads for loss of committed action are lethargy, defensiveness, and busyness. Other assess­ ment criteria include compulsive perseverance, procrastination, inactivity, failure to make or follow through with commitments, poor goal setting, failure to identify barriers and solutions for overcoming them, lack of accountability partners, failure to set up ways to measure progress, unattainable or irrelevant behavioral targets, lack of deadlines, and lack of reinforcers.

The General Approach to Treating Loss of Committed Action If you are a behavior analyst reading this book, direct contingency management methods are likely in your current repertoire, so this section will be brief. Developing clear, operationally defined dependent variables, managing schedules and contingencies of reinforcement, conduct­ ing preference and reinforcer assessments, performing task analyses, and so on are the lock, stock, and barrel of ABA practice. But for some you work with, this terminology is unfamiliar and threatening. If you are working with parents or business leaders, it may pay to frame direct contingency management in terms of SMART goals. SMART is a well-known acronym that

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describes behavioral strategies in nontechnical terms: specific, measurable, achievable, rele­ vant, and time-bound. Again, given the repertoire of this readership, I will not take up space in this volume with operational definitions or examples of these terms.

Using the ACT Matrix to Facilitate Committed Action Throughout this volume, the matrix has been presented largely as an assessment tool. To the extent that clients talk about events that are not current, it is an indirect assessment tool; when clients talk about their current private events, the matrix offers descriptive assessment, and when a therapist asks questions that challenge the client, it may even serve as an experimental verbal functional analysis tool. But the ACT matrix is quite versatile and can be a powerful measurement and intervention aid as well. Quantitative self-report data are generally suspect for many well-documented reasons, and the matrix may not capture the quantity or even the quality of behavioral events accurately. However, using the matrix to teach clients to track response frequency with the aim of improving their discrimination of their more common behavior-environment and behaviorbehavior relations (i.e., covert-overt behavior) is an interesting application. Here, the aim is not data collection, though the data can be a useful adjunct to actual observation of behavior in context. The aim is that the client observes four different potential patterns of behavior: 1) privately feeling connected to values and publicly behaving consistently with their values, 2) privately feeling connected to values and publicly behaving inconsistently with their values, 3) privately feeling distressed and publicly behaving inconsistently with their values, and 4) pri­ vately feeling distressed and publicly behaving consistently with their values. It is this lattermost behavioral pattern that for many learners is most surprising. Until engaging in ACT work, many will not have imagined that they could feel angered and behave cooperatively, feel socially anxious and approach groups of people, or feel depressed and eat, exercise, etc. The matrix offers a visual diagram on which to track the day and time at which any of these four patterns occur. In figure 13.1, Jamal has discussed his relationship with his son Pablo, a typically developing teen boy whose oppositional and defiant behavior has resulted in his being admitted to special education and behavioral services. As predicted, in the early morning (7:15 a.m.), Jamal noted that he felt frustrated and picked a fight with his son. Also as predicted, a few times in the late morning he felt connected with his authentic self and was able to engage in affirming activities with his teen (11:19 and 11:30 a.m.). But then something unexpected happened. Jamal became furious with his son and yet he paused, waited for some desirable behavior, and acknowledged it when it occurred (11:40 a.m.). He was astonished that this happened and it opened his curios­ ity about further intervention options. For the next few weeks, Jamal wanted to try committed action, possibly more as an experiment than anything else. He continued to track the events on his own matrix grids and made use of many ABA strategies that he had not been willing to use before this experience.

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J a m al

Publicly Observable Events 5-Senses Experiencing

I’ll pick a fight with him Tell him he’s crazy and useless I tell him he should live with his mom I’ll leave in the middle of the conversation Hang up X 7:15 a.m. RS

Away

X 7:15 a.m.

I’m tired Frustrated *Sighing* I get mad at my son & disappointed Afraid I’m letting my son walk all over me

We would be running together We’d talk about human rights I’d be acknowledging him for his actions! I’d be inviting him to do ABA X X X 11:30 a.m. 11:19 a.m. 11:40 a.m. X 11:40 a.m.

X 11:19 a.m.

X 11:30 a.m.

SR+ Toward

Being my authentic self Not walking on eggshells Sharing me with my son Bringing curiosity to our relationship Helping him be who he can be

Private Events Mental Experiencing

Figure 13.1

Building Exercises to Facilitate Committed Action Some ACT exercises bear a similarity to the things that ABA practitioners regularly do. ABA practitioners use procedures to undermine delay discounting, the common problem of choosing small, sooner over larger, later reinforcers. ABA practitioners also establish contingency con­ tracts that specify behaviors, the conditions under which they are to be emitted, reinforcers, and when they will be delivered. In the following segments, you will read exchanges in which Tom, a behavior analyst working with Jamal, introduces him to the modified choice point, a procedure that helps undermine delay discounting. After that, Tom will work with Jamal to write out a contingency contract that includes helpful ACT exercises for Jamal to practice.

The Modified Choice Point Jamal’s fear that his son is walking all over him and his experience of walking on eggshells around him suggest that he is possibly getting into fights with his son because doing so avoids or terminates these unwanted emotions and thoughts. Further discussion suggested that expe­ riential avoidance had been an issue in many of Jamal’s relationships. When feeling distressed, he fought because, when doing so, he ceased attending to these emotions. A few novel experiences of behaving congruently with his values were exciting to him. However, the skills needed were also effortful, and Jamal quickly lapsed into old patterns of coercive behavior. When talking with Jamal about this, I noticed that he severely discounted

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the value of a positive long-term relationship with his son in favor of short-term relief from the anxiety he felt trying to manage his son’s behavior with behavioral principles. At the broadest levels, ACT helps people like Jamal make difficult choices, specifically, choices of committed action toward values over experiential avoidance. Bailey, Ciarrochi, and Harris (2014) referred to this as a “choice point.” Tarbox, Szabo, and Aclan (2020) argued that the choice point exercise functions as a concurrent operants paradigm, similar to that which is used to study self-control in basic lab preparations. That is, when it is possible to press one of two buttons, pressing the one on the left produces immediate, but small reinforcers and pressing the one on the right produces delayed, but larger reinforcers. After being required to repeatedly sample each of these response options, most will begin pressing the right button when given the option to press left or right. Figure 13.2 depicts the kind of scenario that is common in life, such as the aversive stimuli produced by Jamal engaging in contingency management with his typi­ cally developing teen. In fact, many times each day we are all confronted by the opportunity to engage in an escape/avoidance response or a response that fails to terminate the aversive stimu­ lus but pays off in dividends later. The choice point model has been widely used by clinicians and has demonstrated broad appeal. However, an evidence-based modification derived from the experimental analysis of behavior is depicted in figure 13.3. Note that in the conceptualization and clinical procedure above, there is one choice point, the moment at which the learner either acts to cash out or continues effortful action toward the larger, later reinforcer. But in an early study on the match­ ing law and delay discounting, Rachlin and Green (1972) demonstrated that animals can be taught to select the larger, later reinforcer over the smaller, sooner one by progressively length­ ening a temporal interval between earlier and later choice points until the work required to obtain a larger reinforcer available after a longer delay is preferred. Thus, a powerful way to generate optimal choice is to prepare a situation that influences preference shifts between two distinct choice points by capitalizing upon a commitment made at the earlier point that is rein­ forced repeatedly over time and again after the second choice point.

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TIME

Larger Positive Reinforcer (values-directed action)

Smaller Negative Reinforcer (experiential avoidance)

“Choice Point” or “Pivot Point”

Figure 13.2

.3 Larger Positive Reinforcer (“valuesdirected action”)

TIME

Smaller Negative Reinforcer (“experiential avoidance”)

Choice Point Y

Intermittent social reinforcers, appetitive self-statements, and renewed commitment responses

Choice Point X

Figure 13.3

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In Jamal’s case, after he had seen the power of using contingency management with his son but returned to using coercion, I asked him whether he thought he might aim higher and go for the larger, later reward of a more responsible long-term relationship with his son by using ABA principles. He said he would, but his past behavior suggested otherwise. The dialogue below ensued. Tom:

Jamal, now that you’ve experienced the powerful way that using ABA principles works, are you willing to aim high and use these skills on a daily basis with Pablo?

Jamal:

For sure. I know I haven’t been this week, but I can.

Tom:

I do get that you want to. And I’m also noting that this is something you’ve done only once or twice and there are some immediate payoffs for you in yelling at Pablo.

Jamal:

You got me, I guess.

Tom:

How about we try something. Would you be willing to stand up with me for a moment? Now, here you are at this moment. You say you’ll turn to the right and go the extra mile with Pablo. But if you turn left, there’s immediate relief. In the past, you’ve very often turned left, correct?

Jamal:

[Nods] Yes, I guess that’s true.

Tom:

So, let’s do something different. I want us both to take several steps back. As far back as we can. Now here, at this spot in the room, this is us together here and now. Pablo’s not here. It’s just us. Here and now, would you make a commitment to me to use the tools I’ve taught you this week?

Jamal:

I guess that’s easy since Pablo’s not here and I can say anything to you.

Tom:

Exactly right. You can. And the moment at which he’ll be back from his mom’s and in your house is a few days away. That’s over there, where we were standing before. You with me?

Jamal:

Yup.

Tom:

So now I’m going to sweeten the pot. For the next few days, I’d like to you to rehearse the differential reinforcement procedure I taught you when Pablo is not at your house. No need to do it out loud, though you can if you want. But if you close your eyes, run through the words I taught, run through the nasty things you imagine Pablo will say in reply, and what I taught you to do next, you’ll have prepped yourself. Can you rehearse like this for two minutes?

Jamal:

That sounds easy enough. Yes.

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Tom:

Great. Can you rehearse like this maybe twice a day for the next few days until Pablo comes back from his mom’s?

Jamal:

Okay, I can do that.

Tom:

When you do this, send me a text message. A quick text—rehearsed. Nothing more elaborate needed. I’ll immediately text back, or at least, I’ll text back as soon as I possibly can. Will you commit to this?

Jamal:

That still sounds doable and I like the idea of the texts. That’s affirming to me.

Tom:

Great. So let’s take a step forward, and here’s where you practice, text, and I text back. Again, we take a step forward, you practice, text, and I reply. Again. Again. Again. Now, when Pablo comes, that’s when this will get tricky. I’ll want you to actually do this with him, continuing exactly what we’ve been rehearsing, and then text me as soon as you can.

Jamal:

Do you want me to tell you how it went?

Tom:

Absolutely. Tell me as much as you can—what he and you did and how he responded. I’ll text immediately. I expect this will be rough. You’ll have a hard time doing this. Maybe you’ll get it right sometimes, and maybe you’ll flub up sometimes. I’ll reinforce your efforts every time. You can phone if you want to talk about what happened. But texting is fine, it’s quick, and I’ll be in a better position to help you when I learn in real time what you’re up to. And now we turn right and continue our step, you act, text, and I reply. Again. Again. You see how this goes?

The modified choice point worked with Jamal because he valued our interactions. Texting back and forth reduced the delay to reinforcement and introduced a new pool of social positive rewards. As an ACT technique, the modified choice point physicalizes delay discounting, a common barrier in teaching self-control. Since self-control is a pivotal skill in treating commit­ ted action issues, modified choice point exercises may be beneficial.

Behavior Contracts Maintaining movement along these lines with Jamal also required the use of a contingency contract. The contract I used with Jamal (figure 13.4) was something he was able to modify and use with his son, so he appreciated it.

I aim to…

I aim to be available for Pablo at least one hour every night before his bedtime on weekdays

Toward being…

Toward being the best dad I can be…

 

Goals 

Values

On other nights, I’ll phone him at his mom’s

Do homework and then play video games with Pablo on Sun, Mon, Tues

To get there, I will…

Behaviors to change

Figure 13.4

Then I feel ashamed, and I sit in front of my own work and can’t get any of it done or veg out in front of the tube! 

I try to avoid feeling bad and thinking I’m a bad dad

I want to zone out in front of the TV

I think he’ll curse and get aggressive with me

I feel sick to my stomach, worry about the future

I don’t know how to do the math Pablo’s teacher assigns

And when this happens…

Likely barriers 

Celebrate leaning into Pablo and following through on my commitment to being the best dad I can be  

Surf the urge

Allow myself to have these “terrible” feelings & thoughts

Notice the thought, thank my mind

Sing it to “Stairway to Heaven”

Get comfortable feeling uncomfortable

Text Tom

I will…

Interventions

By Friday, Aug 13, 2021, I will have helped Pablo with three HW assignments given to my friend and accountability partner Andrea

By this date… I’ll have this to show…

Evidence 

We’ll watch a movie together every Friday that Pablo’s teacher says he handed in all his homework complete for 5 straight days!

Pablo and I get ½ hour video game time together when all homework is done

Andrea will take me out to dinner!

What I’ll get… 

Payoffs 

Committed Action243

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ACT behavior contracts are useful when they include reference to values; distal goals; specific, measurable behaviors; external environmental barriers; interfering private behavioral barriers; the time, place, and people that will observe the behaviors or their permanent prod­ ucts; and reinforcers. The seven columns of this worksheet can be modified in many ways for clients at different developmental and cognitive levels, but the basic ingredients should remain relatively consistent. As such, this ACT behavior contract satisfies the aims of SMART goal setting in a temporally linear visual format. If you sense that a client will balk at the complexity or the linearity of the worksheet, it can be modified, or a simple SMART chart can be adopted to roughly the same end.

Core Competency Practice As in the previous chapters, this section contains a brief description of a clinical situation fol­ lowed by dialogue that ends with a client statement. After that are questions that offer you practice at writing out fitting responses that reflect the competency and rationales for your answers. In these exercises, maintain a focus on the repertoire at hand (in the current chapter: committed action) in order to build skills sequentially. At the end of the chapter, look for the model responses and compare them to your responses. There are limitless ways to approach these issues; no one way is right or best. COMPETENCY 30: The BCBA helps the client identify values-based life goals and build an action plan linked to them. CLINICAL SITUATION: Key to implementing this competency is recognizing the qualities of effective goals described in the ACT Behavior Contract and SMART rubric described above. Use the following chart to develop a committed action plan to help Pablo, Jamal’s fourteen-year-old son. Pablo is in his first year of high school in a class for kids with emotional and behavioral issues. He prefers to relax when he gets home, eat dinner, and then do homework, but right after dinner there are good television programs that he prefers to watch. He believes that he has all the time in the world because his homework is not difficult, but when the TV shows end, he is tired and cannot get himself to complete homework assignments. By the time Jamal begins suggesting Pablo shut off the TV and begin his homework, Pablo is already noticing that he is tired and swears at his father, refusing to get up off the living room sofa. This pattern ends in noncompletion of his work and calls from school on the days after he has spent the night with his father.

Goals 

I aim to…

Values

Toward being… To get there, I will…

Behaviors to change

Figure 13.5

And when this happens…

Likely barriers  I will…

Interventions By this date… I’ll have this to show…

Evidence  What I’ll get… 

Payoffs 

Committed Action245

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ACT and Applied Behavior Analysis

COMPETENCY 31: The BCBA helps clients appreciate the qualities of committed action and to take small steps while maintaining contact with those qualities. CLINICAL SITUATION: The exercise continues from competency 30. Use the modified choice point (see figure 13.3) to assist Pablo in taking small, reinforced steps in a values-congruent direction.

COMPETENCY 32: The BCBA keeps clients focused on larger and larger patterns of action to help them act on goals with consistency over time. CLINICAL SITUATION: The exercise continues from competency 31. Jamal has made substantial progress and is ready to transition to monthly sessions. You wish to make certain that he has a plan to tackle backsliding, mistakes, and other unforeseen breakdowns. Use a SMART chart to help Jamal transition successfully to monthly sessions.

SPECIFIC

• What do I want to accomplish? • What are the requirements?

MEASURABLE

• How will I measure progress?

ACHIEVABLE

• Are there sub-steps that will make this easier?

RELEVANT

• What does accomplishing this make available?

TIME-BOUND

• What is the completion date? • Who will know that I completed it?

Committed Action247

COMPETENCY 33: The BCBA nonjudgmentally integrates client slips or relapses into the process of keeping commitments and building larger patterns of effective action. CLINICAL SITUATION: The exercise continues from competency 32. After a few successful weeks, Jamal noticed Pablo backsliding and began goading Pablo to do his homework. He had been caught off guard by Pablo not sticking to the plan. When Jamal goaded him, Pablo had a major meltdown in which he destroyed the television and dining room table. Jamal is furious and has put Pablo in a bedroom lockdown restriction condition for two weeks. Pablo has destroyed his room now and the situation appears to be escalating. You have the opportunity to meet with Jamal before Pablo comes home. Use this time to work with Jamal on his relapse into coercive practices.

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Core Competency Model Responses COMPETENCY 30: The BCBA helps the client identify values-based life goals and build an action plan linked to them. Model Response 30a

Values

Goals 

Toward being…

I aim to…

Toward building a good relationship with my dad

Complete my HW before dinner Use communication skills to negotiate and to manage difficult conversations 

Behaviors to change

Likely barriers 

To get there, I will…

And when this happens…

Limit downtime to 15 minutes when I get home

When friends Ask if I can call call we want them back after to talk for dinner a while Put a message Sometimes on my phone people phone that if they while I’m leave a message, doing HW I’ll phone them back in the I get really evening mad when my dad Ask for badgers me  5 minutes and set timer

Do HW for 1 hour before taking a break

Interventions Evidence 

Payoffs 

I will…

By this date… I’ll have this to show…

What I’ll get… 

I’ll keep a phone log and show Dad before dinner

20 minutes video time

I’ll put the message on my phone and leave it in the living room

20 minutes video time

Remind myself it’s worse doing HW at night 

20 minutes video time

= up to 1 hour video game time each night 

Do this in front of Dad  

Figure 13.6 Explanation: Pablo is a teenager and typically developing, so no modifications were necessary. As stated

earlier, it is always possible to modify this worksheet to be more or less complex based on the skills and needs of the client.

Committed Action249

COMPETENCY 31: The BCBA helps clients appreciate the qualities of committed action and to take small steps while maintaining contact with those qualities. Model Response 31a Tom:

Pablo, in a way, you are your father’s son. You are similar in that when things get difficult, neither of you sees the value of waiting for things you want.

Pablo:

Very funny. I’m not like him.

Tom:

Okay, well, maybe not in all ways. The way you’re different is that he likes to do chores immediately when he gets home. You like to put things off until later.

Pablo:

He freaks out about that.

Tom:

And you’ve agreed to limit your downtime to fifteen minutes when you get home. The thing is, have you ever done that before?

Pablo:

Nope.

Tom:

So, that might be a problem. But I have an idea. Let me illustrate. Would you be willing to stand up with me for a moment?

Pablo:

For a moment.

Tom:

This may be kind of interesting for you. More so than you think. So. Here we are. You and I are standing here, now. To my right, there is your homework. You can take a fifteen-minute break, but after that, it’s a hump. At the end of the tunnel, if you get it done early, you’ve got the whole night for TV, video games, and phone calls. To my left, you chill out now, play video games until dinner, and then you’re stuck doing homework at night. If you watch TV, it’s homework into the late night hours. What’re you going to do? Turn left or turn right?

Pablo:

Duh. I’m going to take a break and then get to work. Turn right.

Tom:

Well, that’s interesting. I believe that’s what you want to do, but that’s what you want to do now as we’re talking about it. The thing is, this would be very new behavior for you and it’ll be hard. Especially if friends start phoning you.

Pablo:

Oh. Well, yeah.

Tom:

But I have an option that might change things a bit. I don’t know if this will work. But maybe it’s worth a try.

Pablo:

What’s the plan?

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Tom:

It goes like this. You and I step back to the edge of the room. Now here we are and it’s a few days before you come home to your dad’s place. Here and now you make a commitment to homework in the afternoon after a fifteen-minute break.

Pablo:

No sweat. That’s days away.

Tom:

Spot on. It’s days away. Now, something you and I have talked about in the past is how useful practice is. That’s how we got past the basketball free throw problem you had last year on junior varsity.

Pablo:

That was rad.

Tom:

So, let’s do something similar here. Today, three days before you’re back at your dad’s place, we start practicing. At your dad’s place, twice a day, you’ll close your eyes, set the timer for fifteen minutes, and jump into action for homework as soon as the buzzer goes off. But to practice, you close your eyes and rehearse this way for just a minute. Then, you text me to let me know you’ve done it. I’m gonna make it my business to text you back as soon as possible—immediately, if possible. To let you know I think you’re rad. Practice now. Just another few seconds. Great. Now fast-forward four hours, and let’s take a step forward, and repeat. And again. Now, here we are at the point where we started. It’s “go” time. You’re at your dad’s place after school. Turn right, and you keep doing what you’ve been doing. You follow the commitment you’ve been following in practice: take fifteen minutes, then break out the books. Turn left, get an immediate out. But then you’re up at night doing homework.

Pablo:

I get it. It is like foul shot practice, only with my eyes closed.

Tom:

The more you practice, the more we text, the easier it will be when you get to “go” time.

Pablo:

Okay. I think this is kind of lame, but I’ll try it.

Tom:

Let’s give it a go.

Explanation: For the record, I did do something like this with Pablo. He thought it was lame, but he was

willing to try. Note that it was not necessary to address his calling it lame. That would have been coercive. Best to let that kind of behavior go. The general procedure was the same as using the modified choice point had been with Jamal.

Committed Action251

COMPETENCY 32: The BCBA keeps clients focused on larger and larger patterns of action to help them act on goals with consistency over time. Model Response 32a

SPECIFIC

• What do I want to accomplish? • What are the requirements?

• Keep getting homework done

before dinner

• Set 15-minute alarm; set phone

message; give phone to Dad

• Practice twice a day at Mom’s

MEASURABLE

• How will I measure progress?

• Text Tom after practice and when

ACHIEVABLE

• Are there sub-steps that will make this easier?

• Ask Dad for help; ask for extra

RELEVANT

• What does accomplishing this make available?

• Phone time, video game time, TV

TIME-BOUND

• What is the completion date?

• Weeknights at Dad’s

• Who will know that I completed it?

• Tom via text

at Dad’s time

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ACT and Applied Behavior Analysis

COMPETENCY 33: The BCBA nonjudgmentally integrates client slips or relapses into the process of keeping commitments and building larger patterns of effective action. Model Response 33a Jamal:

I screwed up pretty bad, didn’t I?

Tom:

I was afraid you were going to say that. I can’t tell you how often I’ve seen this happen. People make progress and then they relapse.

Jamal:

I’m not a drug addict.

Tom:

Neither am I. But guess what? I relapse on old behaviors, too. No one I’ve ever met makes substantial behavior changes without some backsliding. It’s part of making progress.

Jamal:

Two steps forward, one step back.

Tom:

Two forward, one back. And this is a bit more challenging now because you know what there is to do and you’ve rehearsed it. I have an ask. Would you be willing to do a bit of writing? Would you write for a few minutes about how you think a relapse like this affects you, Pablo, and your relationship? What’s difficult about what I’m asking you to do is that I want you to try to notice the self-judgments that show up as you begin writing, but instead of writing from them, write about them. What I mean is, if for example you are saying to yourself, “I can’t manage my own emotions,” the way to write about this is, “I’m noticing that I judge myself unable to manage my own emotions.” Do you hear the difference?

Jamal:

Yes; that’s very interesting.

Tom:

Give it a go.

Jamal:

[After writing] Can I show it to you?

Tom:

Yes, please. [Reads] This is good. Very good, in fact. You are honest and looking at your self-evaluations rather than from them. That’s not easy to do. The next thing that I’d like to do is to come back to the behavior contract we wrote and go through it with you to see whether there’s anything new that we need to add. Specifically, I imagine that now, after this event and writing just now, you may have some new ideas about the internal barriers that can show up. Let’s identify them and develop some ACT strategies for managing them—one by one. Something I want to check in with you about is this: are you worried that you are going to relapse again?

Committed Action253

Jamal:

Why do you ask? I was actually thinking about that.

Tom:

It’s very common. I go through this myself. When I’ve let myself down, I get worried that it will be a pattern I can’t shake. Some people respond to this with a rule: “If I don’t try, then I won’t fail.” It’s better we get that out in the open if you’re having that thought and address it if you are.

Jamal:

What if I am?

Tom:

Let’s look at this. It’s true. If you don’t try, then you won’t fail. And if you don’t try, then you won’t succeed. And if you do try, then you might fail. But is failure forever?

Jamal:

I might not fail. But if I do, then no, it’s not forever. I guess it’s worth trying. Try, try, try… Michael Jordan said something about that once, right? Something about how he’s missed more shots than he’s hit.

Tom:

You’re on point. That’s it. Let’s shoot some hoops and expect a few misses. Misses are not losses. It’s all practice.

Explanation: Relapses like Jamal’s do occur frequently, as behavior analysts know well. Nevertheless, some

behavior analysts expect that after moving to ACT interventions, problems they had conducting direct contingency management interventions will disappear. That is not the case. When using ACT and ABA combined, it is very possible that openness to contingency management will increase, but relapses will still occur. The important things are to prepare clients for their possibility, respond nonjudgmentally when they do occur, and help the client recommit. After substantial relapses, there is a strong possibility that a client will be unwilling to try again for fear that they will be unable to maintain their fidelity to the plan. Clients may develop a self-rule, “If I don’t try, then I won’t fail.” Addressing this head on after a relapse is an act of willingness. Developing a plan for it is recommitting to action. Powerful stuff.

CHAPTER 14

Scope of Practice for the Behavior Analyst Using ACT

No book on the use of ACT in applied behavior analysis would be complete without addressing the way that its use fits within ABA scope of practice defined by state laws, licensing boards, and the Behavior Analyst Certification Board. The matter is of importance because there is a potential for harm to clients when practitioners use techniques that they are untrained and uncredentialed to use. Indiscriminate use of ACT by those working under ABA credentials could devolve into practices that require specialized training that behavior analysts do not receive in their formal education programs and that are not within the current legally defined scope of practice of ABA. Although these legal limits vary from region to region, there are com­ monalities to ABA practice limits across state lines within the United States. Specifically, within the United States, ABA does not include psychotherapy. This is different in Canada and many European nations, but within most regions of the United States, ABA practitioners using ACT must steer clear of psychotherapy. As this work is being published initially in the United States, it is fitting to address the question most commonly posed to ABA workers practicing ACT: How do you know whether you are staying in your lane? Or, put another way: If you are using ACT, how do you know you are not practicing psychotherapy? This is a legitimate ques­ tion. If ACT is a psychotherapy, how could it also be used in ABA? To answer this question, it is worth examining prevalent definitions and characteristics of ACT, psychotherapy, and ABA. Before examining the most common of these definitions, it is also worth recalling the a-ontological stance of ACT discussed in the first chapter of this volume. This stance, derived from Skinner (1945), suggests that operational definitions used in science are local to the context in which they are offered. Any given term can be used in any context, provided a speaker outlines the controlling variables that govern its use. For our purposes in this volume, operational definitions of ACT, psychotherapy, and ABA are useful in the demarcation of prac­ tice boundaries that workers are required to observe in the United States. In any region, when clients ask, “Can you help with this issue?” or “Can you provide this type of service?” their ques­ tions are discriminative for reinforcement contingent upon affirmative answers. However, addi­ tional contingencies come to bear upon the practitioner answering these questions in specific regions. In the United States, laws and regulatory agencies limit practice within certain bound­ aries, and failure to comply can result in loss of credentials and criminal charges.

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Defining ACT Thus, it is important to examine current definitions and characteristics of ACT, as related to psychotherapy. The Association for Contextual Behavior Science website offers these definitions: ACT is an orientation to behavior change and well-being that is based on functional contextualism as a philosophy of science, and behavioral and evolutionary science principles as expanded by RFT. As such, it is not a specific set of techniques or a spe­ cific protocol. ACT methods are designed to establish a workable and positive set of psychological flexibility processes in lieu of negative processes of change that are hypothesized to be involved in behavioral difficulties and psychopathology. A second definition states: Acceptance and Commitment Therapy (ACT) is a unique empirically based psycho­ logical intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility. It is important to observe that these definitions do not indicate ACT is a psychotherapy or talk therapy. Rather, it is an orientation to behavior change and well-being and it is a psycho­ logical intervention. It is also germane to note the unambiguous statement that there are no techniques or protocols that would require formal training. Thus, ACT is not limited to talk between therapist and client. As such, ACT is a model of psychological flexibility that can include many different kinds of activities, some of which are suitable for use by teachers, others apt for nurses, others appropriate for community organizers, others that are of use to athletic coaches, some activities that could be useful for business leaders, some fitting for use by behav­ ior analysts, and still others best for use by psychotherapists.

Defining Psychotherapy If ACT is not psychotherapy, then it is important to distinguish what is psychotherapy. The American Psychological Association (2022) defines psychotherapy as “a collaborative treat­ ment based on the relationship between an individual and a psychologist.” This definition con­ tinues, “Grounded in dialogue, it provides a supportive environment that allows you to talk openly with someone who’s objective, neutral, and nonjudgmental.” This definition says nothing about behavior change and explicitly describes a process that begins and ends with talk in a supportive relationship between client and therapist. Thus, it appears ACT may include psy­ chotherapeutic talk therapy, but psychotherapy is expressly limited to talk therapy in ways that ACT is not. Additionally, psychotherapy may target overt behavior change, but it does not include a mandate to do so. The only mandated feature of this form of treatment is collabora­ tive dialogue between therapist and client.

Scope of Practice for the Behavior Analyst Using ACT257

Defining ABA Defining ABA may be more challenging. Practice areas for which ABA research has been pub­ lished include general and special education, autism, intellectual and developmental disabili­ ties, attention deficit disorder, movement disorder, brain injuries and diseases, behavior disorders, substance abuse disorders, dementia, feeding disorders, home and workplace safety, vehicular and pedestrian safety, organizational behavior management, animal welfare and training, conservation, parenting, child welfare, and health and fitness. With the diversification of areas in which applied behavior analysts work, it has become necessary to define what ABA is in a way that it is inclusive of methods applicable to the full range of contexts in which ABA is practiced. Perhaps the clearest current definition of ABA can be found in the Association of Professional Behavior Analysts (APBA) Model Behavior Analyst Licensure Act, adopted in 2018. Although merely the association’s recommendations to legislators for language to be used in various parts of state licensing laws, the statement found here is clear and forthright: Practice of Applied Behavior Analysis. The design, implementation, and evaluation of instructional and environmental modifications to produce socially significant improvements in human behavior. The practice of applied behavior analysis includes the empirical identification of functional relations between behavior and environmen­ tal factors, known as functional assessment and analysis. Applied behavior analysis interventions are based on scientific research and direct and indirect observation and measurement of behavior and environment. They utilize contextual factors, motivat­ ing operations, antecedent stimuli, positive reinforcement, and other procedures to help individuals develop new behaviors, increase or decrease existing behaviors, and emit behaviors under specific environmental conditions. The practice of applied behavior analysis excludes diagnosis of disorders, psychological testing, psychotherapy, cognitive therapy, psychoanalysis, and counseling. Of importance, the APBA recommended definition unequivocally excludes psychotherapy and counseling. The BACB (n.d.) offers a similar but more succinct statement in the Ethics Code for Behavior Analysts: Behavioral Services. Services that are explicitly based on the principles and proce­ dures of behavior analysis and are designed to change behavior in meaningful ways. These services include, but are not limited to, assessment, behavior-change interven­ tions, training, consultation, managing and supervising others, and delivering con­ tinuing education. The BACB definition stresses that an emphasis on meaningful behavior change is the criti­ cal feature of ABA services. Taken together, the APBA and BACB suggest that ABA is char­ acterized by an emphasis on behavior change and that psychotherapy is an excluded practice.

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ACT and Applied Behavior Analysis

These stipulations appear to be consistent with ACT defined by the Association for Contextual Behavior Science as “an orientation to behavior change and well-being” and “psychological intervention.” It is important to note that ABA practiced with verbally competent clients involves col­ laborative dialogue. Without dialogue, ABA would be ineffective. Without collaboration, ABA would be autocratic. In fact, researchers have recently sought to operationalize and train col­ laborative dialogue as compassionate care in ABA (Taylor, LeBlanc, & Nosik, 2019). Thus, ABA (and ACT used within ABA) is likely to include collaborative talk that may have overlap­ ping features with psychotherapy, but because ABA (and ACT used within ABA) is expressly aimed at changing overt behavior, it remains distinct from psychotherapy.

Some Current Dimensions of ABA Both the BACB Task List and the APBA further stipulate that for an intervention to be char­ acterized accurately as ABA, the seven dimensions articulated by Baer, Wolf, and Risley (1968/1987) must be present. That is, interventions much be: Applied—focused on socially important behavior Behavioral—focused on overt behavior that can be observed and measured Analytical—subjected to procedures that demonstrate observed results are due to the intervention and not due to some other event Technological—described so that others attempting can replicate the procedures Conceptually systematic—explained in terms of basic principles derived from the experi­ mental analysis of behavior Effective—produces results to a practical degree Generalized—generates durable results that transfer to new environments or behaviors Tarbox et al. (2020) and Dixon, Hayes, Stanley, Law, and Al-Nasser (2021) discussed the use of ACT in ABA with respect to these dimensions of practice; readers interested in compre­ hensive scholarly treatments of these aspects of ABA ACT practice are encouraged to read those accounts. Briefly, if you are an ABA practitioner observing that a client is not responding to direct contingency management and you suspect that they are engaging in private interfering behavior, you are beholden to uncovering and shifting the contingencies that maintain the private behavior so that you can bring overt behavior under relevant stimulus control. You may not be able to control these contingencies, but you can influence them by evoking new overt behavior and establishing relevant consequences. In principle, there is nothing new in this. Manipulating contingencies to change behavior is the stuff of ABA. However, in practice, some

Scope of Practice for the Behavior Analyst Using ACT259

of the contingencies that are influenced in ACT are indirect and less available for direct manip­ ulation. Thus, ACT is indirect contingency management with the explicit purpose of reinvigo­ rating direct contingencies that control overt behavior. Seen in this light, a practitioner using ACT in ABA ought to be prepared to explain how their aim is to produce changes to socially relevant (applied), observable, measurable behavior (behavioral), that can be shown to have been produced by the treatment and not spurious envi­ ronmental changes (analytic), with techniques that are described in precise ways so that others can replicate them (technological), and with outcomes that can be explained with reference to principles derived from the experimental analysis of behavior (conceptually systematic), that are powerful (effective) and long-lasting, and that transfer to novel environments and behaviors (generality). Given that a practitioner’s use of ACT in ABA is consistent with the dimensions of ABA articulated by Baer, Wolf, and Risley (1968) and Bayer and Risley (1987) that they avoid using talk therapy techniques that are trademarked or otherwise protected by law, their use of ACT would be consistent with ABA and well outside the APA’s definition of psychotherapy.

The BACB Task List For the purposes of examinations and certifications, the BACB defines ABA as “the content of the BCBA, BCaBA, and RBT Task Lists.” That is, ABA is what a behavior analyst does, and what a behavior analyst does is defined by the BCBA Task List. Given this, several BACB 5th Edition Task List content areas are important to discuss. Content Area F-3 requires the behavior analyst “identify and prioritize socially significant behavior-change goals.” ACT explicitly targets socially significant overt behavior as committed action linked to stated values. Many psychotherapies similarly aim to promote overt behavior change. However, not all do, and this is not a defining characteristic of psychotherapy, accord­ ing to the APA. In contrast, it is a central aspect of both ACT and ABA. Content area G-1 asks behavior analysts to “Use positive and negative reinforcement pro­ cedures to strengthen behavior.” In ACT committed action work, practitioners use contingency contracts, accountability partners, home practice assignments later viewed by the therapist, and other strategies that result in positive reinforcement wherever possible and desirable negative reinforcement where necessary. Behavior strengthened under negative reinforcement is avoid­ ance and escape behavior. These repertoires are necessary, but negative reinforcement tends to narrow responding to those behaviors that avoid discomfort and pain. In contrast, positive reinforcement evokes expansive repertoires of behavior that contact various quantities, dura­ tions, and latencies to accessing reinforcers. Thus, ACT work in ABA tends to focus on strengthening both repertoires and undermining the over-reliance upon behavior that contacts negative reinforcement. Task List Content Area G-2 requires that behavior analysts “use interventions based on motivating operations and discriminative stimuli.” ACT interventions help clients construct

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augmentals, or rule statements pertaining to remote consequences. For example, the augmental “Sharing is caring” helps younger clients focus on the long-term benefits of behavior that fore­ goes smaller, immediate reinforcers in favor of larger, later ones. In essence, once they have been emitted, augmentals are stimulus products of verbal behavior. These rules are no longer behav­ ior; they are stimuli in the environment that serve as verbal conditioned motivating operations. The term verbal conditioned motivating operation may need a more robust scholarly treatment than is possible here; space limitations preclude such discourse. Suffice it to say that it is pos­ sible to expand the molecular motivating operation construct to include molar behavior-envi­ ronment relations that are the result of verbal behavior. Augmentals as such strengthen the influence of other motivating operations. In the example above, they may abolish the reinforc­ ing effectiveness of toys as they increase the reinforcing effectiveness of remote consequences, such as an enriched bond with a sibling with whom one has shared their toys. Other ACT interventions focus on increasing the salience of faint discriminative stimuli. For example, bringing attention to the soles of your feet so that you can “surf” the urge when experiencing impulses to use alcohol or drugs helps transfer stimulus control and improve the likelihood of maintaining a program of abstinence. Content Area G-6 petitions behavior analysts to “use instructions and rules.” The capacity to learn and follow verbal rules provides humans with substantial evolutionary advantage. Humans need not encounter the gastric distress that comes from drinking colorful dishwashing liquids; instead, we can learn from the rule to stay clear of the interesting-looking cleaning products. Likewise, we can learn rules such as sharing is caring. But overextended rules can jam behavior into cul-de-sacs in which reinforcers are small or nonexistent. ACT involves exercises that enhance effective rule following while undermining the excessive dominance of rules fol­ lowed outside the contexts in which they work. In this way, ACT furthers G-6 aims by targeting rule-constricted behavior for deceleration and increasing sensitivity to contingencies that lead to new, more successful rule development. G-10 states that behavior analysts “teach simple and conditional discriminations.” ACT interventions frequently employ multiple exemplar training in simple discriminations of the contexts in which established rules may be effective and those in which they are less so. Most ACT interventions go on to train conditional discriminations that juxtapose properties of situ­ ations in which to follow gradients of one rule and other situations in which to employ gradients of a different rule. This kind of training brings behavior under the multiple control of pooled direct- and indirect-acting contingencies. Truly exquisite stimulus control results in the finegrained but rapidly changing control that combined verbal and physical environments share over behavior after a variety of ACT metaphors and exercises are used in practice. G-19 suggests that behavior analysts “use contingency contracting.” ACT contingency con­ tract examples are included in this volume. Contingency contracts can have a chilling effect upon some learners when they are introduced without first working to reduce the stigma of having someone else help manage one’s affairs. Since ACT helps change the contexts in which shame might otherwise dominate a client’s attention, it is a useful aspect of treatment that

Scope of Practice for the Behavior Analyst Using ACT261

involves contingency contracting. As such, ACT contingency contracts often include strategies for managing both direct- and indirect-acting barriers to treatment adherence. Content Area G-20 stipulates that behavior analysts “use self-management strategies.” Because many ABA clients are not regularly in session with their behavior analysts, ABA prac­ titioners use self-monitoring, contingency contracting, and public accountability strategies. These tools strengthen the otherwise weak control exerted by the outside world and improve behavioral outcomes. ABA ACT practitioners use these tools in the context of strategies that increase awareness of self-labels, self-rules, past situations, and future events that would other­ wise dominate attention and stall important behavior from leaving the gate. Content Area G-22 asks behavior analysts to “use procedures to promote maintenance.” The seventh dimension of Baer and colleagues’ (1968) definitional piece on the features of ABA, maintenance is often a weak link in ABA programming. However, ACT helps improve maintenance by teaching clients to use their verbal skills effectively in ways that bring less salient features of the environment into view and decrease the importance of strong but nonop­ timal stimuli in the current milieu. For example, the presence of alcohol and friends drinking in the dorm room on a school night may evoke a college student’s drinking rather than study­ ing. However, ACT work done over a period of time in training sessions before encountering this situation can improve the salience of other small but important reinforcers for abstaining from drinking in the immediate context and generate action that will likely contact the impor­ tant, delayed consequences of studying. Maintenance effects such as these that overpower non­ optimal positive reinforcers are uncommon in direct contingency management strategies used with verbally able clients because those with verbal skills are able to use logical verbal defenses to rationalize poor behavior and justify its unwanted results. ACT helps promote maintenance by tunneling beneath this wall of verbal defenses to reveal a path to desired outcomes.

Some Current Dimensions of ABA Revisited Returning to the implications of Baer et al.’s seminal paper (1968), two things are important to note. First, the authors wrote this paper to describe the defining features of ABA research. They were not addressing practice per se. They articulated the vision that practices vetted in applied research would lead to widespread adoption across the society, but the dimensions of ABA they described were intended as guides to investigators developing unprecedented, applied behavior research practices. The use of these dimensions to define the practice of ABA in natural environments represents an extension beyond the scope of the original article. Perhaps too, it represents some lack of clarity between research and service domains of the field. Regardless, it is a high bar, and one that most practitioners do not clear. For example, most ABA providers do not test their curricula or frequently used interventions to evaluate whether results obtained are due to these procedures. The analysis in applied behavior analysis is not a common feature of most service applications of the science. Thus, if ABA practitioners using ACT take pains to do more than applied behavior designs in their practices, they will have met

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the standard that Baer and colleagues set and gone beyond what most ABA service providers do to meet this aim. Second, the title of Baer et al.’s seminal paper is “Some Current Dimensions of Applied Behavior Analysis” (italics mine). The authors do not elaborate, but it is easy to derive that more dimensions of ABA could be added and that some of the original seven may not survive the test of time. Clearly, as stated in Baer and Wolf’s 1987 follow-up paper, the original seven have survived; they are still relevant, at least to research. But it is interesting to speculate that recent discussions in the field pertaining to burnout (Plantiveau, Dounavi, & Virués-Ortega, 2018), equity (Szabo, 2019), diversity (Fong, Ficklin, & Lee, 2017), harmful practices (Boyle, Bacon, Brewer, Carton, & Gaskill, 2020), and the use of ACT (Tarbox et al., 2020) are leading to the need to evaluate compassion as an eighth dimension of ABA. If so, ACT provides a framework from which to instantiate and evaluate compassionate practice in ABA service.

Encountering Emotional Behavior: Check Your Scope of Competence With regard to compassion in ABA, some express the concern that ACT could involve behav­ ior analysts eliciting complex emotions in a manner that is characteristic of psychotherapy. If so, behavior analysts may not be prepared through their training to help clients manage such emo­ tions. Psychotherapists receive formal and practical training in assisting people with sorting through emotional content. Clients sometimes associate their most uncomfortable emotions with the therapist, so these practitioners are trained in the development, maintenance, and repair of their therapeutic alliance with those they serve. As discussed elsewhere in this volume, it would be beneficial for behavior analysts working in varied settings among clients with complex verbal skills to seek out therapeutic alliance training, regardless of whether or not they are using ACT. Along similar lines, many clients in these settings have or are currently experi­ encing trauma, so behavior analysts may also be wise to receive training in trauma-informed care. If one is using ACT in ABA, these trainings are especially important. At the same time, such training does not afford behavior analysts a license to practice psychotherapy. Traumainformed care is different from trauma therapy. One interesting point is that when children cry, it is taken for granted that behavior ana­ lysts can evaluate the extent to which this is operant or respondent behavior and treat it accord­ ingly. Yet children are capable of complex emotions and many have had experiences in life that have left them traumatized. Given that the largest area of ABA work continues to be serving children, it seems like low-hanging fruit that behavior analysts should receive training in trauma-informed care and the therapeutic alliance, and I encourage students to request this training in their university programs. Be that as it may, such training is not currently part of the ABAI-verified course sequence that is required in the United States.

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It is easy to see how this gap in behavior analyst training could result in difficulties. ABA work even without ACT can elicit intense emotions. ACT in ABA involves facing emotions to facilitate the move from avoidance to meaningful action. Values work often evokes thought about the disconnect between stated areas of relevance in life and actual behavior. Willingness work often brings up emotions that clients have never contacted or have tried to suppress and eliminate. Other ACT repertoire work is equally capable of sparking difficult memories, bodily sensations, thoughts, and emotions. ABA ACT practitioners need to be prepared for this and respond within their scope of practice and their scope of competence. One way to navigate this maze is to begin and end with a focus upon socially important, observable, measurable behavior. If a client says they are in distress or demonstrates behavior associated with challenging emotions, a behavior analyst can show empathy using a caring tone of voice, soft eye contact, and other behavior that demonstrates compassion. Simultaneously, it is usually advisable to gently return the client’s focus to the ACT exercise and the specific behavior that is targeted for change. This need not be an abrupt move; rather, the behavior analyst may suggest a number of strategies for refocusing, such as a present moment exercise, a brief pause, a self-management strategy, or simply waiting out the client’s reaction and asking if it is okay to proceed. Behavior analysts should be on the lookout for signs that a client’s distress is severe enough to warrant recommending they contact another professional. In these cases, asking the client for permission to facilitate a referral is a useful strategy. Behavior analysts should also make certain when a client expresses intense, aversive emotion that the exercise they are engaging in does not require them to participate in ongoing emotionally evocative intrapersonal explora­ tion. Deep and disturbing emotions are behaviors, and behaviors are what ABA professionals address, but not all behavior is within the scope of competence of a behavior analyst. As a general rule, it is acceptable to ask clients to approach difficult emotions when doing so leads to their being willing to take action toward meaningful overt behavioral targets. But when intensely challenging emotions are elicited, it may be wise to back off. Rather than avoiding them or punishing their expression, behavior analysts can listen with empathy and gently redi­ rect attention to the learning target in a way that is affirming to the client. In short, when conducting ACT in ABA, if the session gets emotionally hot and it is not setting the occasion for socially important behavior changes, the behavior analyst is cautioned to back off and try doing something different.

Summary In summary, ACT, psychotherapy, and ABA are defined in the context of local laws and the oversight of regulatory agencies. Internationally, ACT is used by many professions, only some of which use ACT as a psychotherapy. In the United States, psychotherapy is defined in a way that

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is inconsistent with the way ABA is defined. This means that ABA ACT practice in the United States must be sensitive to these practice boundaries. The BACB 5th Edition Task List and Baer et al. (1968/1987) provide guidance that suggests nonpsychotherapy applications of ACT could be within the scope of practice of behavior analysts. Nevertheless, behavior analysts should be careful to stay within their legal scope of practice as well as their trained scope of competence. When activities seem overly close to the line of psychotherapy or at the edge of one’s training, behavior analysts are cautioned to step back and try something different.

The Future Is Green

It seems customary in ACT books to lead with flashy quotations from Mary Oliver, Pema Chödrön, and other authors who write engagingly about the human condition. Kermit the Frog has never been one of the poet laureates or spiritual giants whose words have galvanized com­ mitted action in an ACT text. And yet I’d like to evoke the beloved Muppet and Sesame Street character Kermit the Frog, oddly appropriate to signal the end of this book and of the work you are about to do. Kermit reminds us that being green can be a gift, not the curse we sometimes make it out to be. Jeff Kupfer, my very wonderful clinical mentor who encouraged me to go to graduate school, taught me that passing the BCBA exam was not proof you have arrived; it is permission to get on the road and drive. Likewise, if you have read this book and practiced the exercises, you have just enough skill to go out and be dangerous on the road. It would be most sensible now for you to reach out to someone with expertise in both ABA and ACT to continue down this road. Because you will make mistakes. You will get stuck. But if you are practicing ACT in your own life in a meaningful way and have someone skilled to turn to now and again, you will learn to sit in the muddiness of the moment without trying to control or eliminate it. There is no shame in getting stuck. The shame is in pretending that you have all the answers when you do not. That is a shame because others can sense it, even if they do not say so. Imagine a world where you see more after admitting you were not looking, hear more after acknowledging you were not listening. This is the world of ACT in practice. You will assist more humans in pursuing a life worth living once you learn to observe your own learning as a process and that you are, perhaps forever, a beginner. Being a beginner is like being a green tadpole: wiggly, with new legs that don’t quite work yet. Kermit the Frog was right: it’s not easy being green. Fortunately, there are places you can go to find a community of friends who are committed to ongoing learning about behavior analysis, ACT, RFT, and the foundation that Skinner laid. If you are considering graduate school, there are now behavior analysis labs dedicated to ACT and RFT. But if you have completed your schooling, the most important resource to further your development is the Association for Contextual Behavior Science (ACBS, n.d.). Becoming a member of ACBS is easy. Membership is values-based; that means you pay what you think your membership is going to be worth to you for the upcoming year. If you are on a limited budget this year, offer what you can; many others will pay more than their share to make it pos­ sible for you to pay minimally and still become a member. There is a minimum: $13 USD. Compare that to the price of membership to almost any other major scientific society to get a sense of how good an offer that is. Pay this amount or more if you can afford to do so. At this

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time, there are more than eight thousand members of ACBS from all over the world. Members learn about and contribute to the philosophy of science, basic and applied research, and prac­ tice domains of the field. Science is progressive, and it is often the greenest, newest members who bring questions to the community that lead to tomorrow’s dynamic advancements. There are listservs, regional chapters, and special interest groups related to ABA, autism, children, families, and staff training. There are video trainings, PowerPoints, PDFs, and a wide range of other resources available on the ACBS website (www.contextualscience.org). Many professionals learning ACT are concerned that they should not use this modality of treatment until they have been properly certified. But there is no ACT certification process. The ACBS community has repeatedly voted to forego this to maintain the communitarian, nonhierarchical structure of the association. People who train others can opt to be peerreviewed, and it is a good idea for you to get training and consultation from those who have undergone and passed the peer-review process. At some point, ACBS will also have a voluntary competency review for ACT practitioners. These processes are different from certification in that no one is required to undergo them and they do not constitute credentials per se. Anyone is free to use ACT at any time. But quality introduction and advanced trainings for practitio­ ners are important, so it is wise to look for members of the peer-reviewed trainers’ group when considering your next training. At the time of this writing, there are more than one hundred peer-reviewed trainers across the globe and from all walks of life. It is a diverse and gifted group and many have some background in ABA. Most likely, your stance is that behavior is lawful and orderly; that we learn about it through observation, experimentation, and replication; that we are in command when we can explain what we have found simply and without recourse to unseen or hypothesized variables; and that philosophic doubt provides us with an engine with which to drive beyond falsities in our way. If so, then ACT offers an additional tool with which to observe private behavior, amplify it when it is useful, and turn down the volume when it is less so. ACT helps generate behavioral momen­ tum during periods of inertia and shifts the verbal context so that important, remote conse­ quences of behavior become salient over weak, immediate ones. If you believe that learning ACT is going to be easy, I am nervous for you. Rather, I suspect that learning to use ACT in your own life and in your practice with others is going to be deeply challenging. It will, in many ways, be like being green. As Kermit sings, “It’s not easy being green” (Raposo, 1970). That is my hope for all of us—that we continue to be green. I hope you’ll use the skills you’ve learned in this book and that you’ll go out, with some consultation or supervision from others, and get comfortable being uncomfortable. Go make a few small mistakes and clean them up promptly. Go for a walk with your client’s troubles, stumble, stand back up, brush off the dirt, and resume walking. Go make a few bold moves and help someone learn to dance, to sing, to fly the airplane of their lives. Continue being diligent with direct contingency manage­ ment strategies and add in some indirect contingency management where it would be useful to do so. You’ll be green. And maybe then the future of ABA will be green, too.

APPENDIX

The ABA ACT Core Competency Rating Form

Adapted from Luoma, Hayes, and Walser (2017), the ABA ACT Core Competency Rating Form is an instrument that will help you identify your current ACT repertoires that are at strength and those that need improvement. You may wish to begin by completing this form on your own and after working through the exercises in this volume and reading supplemental resource material to further develop your skill set. After that, an important next step is to seek out a trainer who can help you sharpen your skills. Today, there are many ACT trainers who operate in applied behavior analysis contexts. Some of these trainers have additional skills that may be of importance to you. For example, some work in non-English-speaking contexts, others with those who identify as BIPOC, and still others who serve in gender and sexual minority communities. Seeking guidance from trainers familiar with the issues you face is vital to your growth as an ACT practitioner. You may also look on the ACBS website to find peer-reviewed ACT trainers with whom to work. The peer review process is rigorous; those who pass are required to have demonstrated competence in ABA, RFT, and radical behavioral philosophy, each of which is central to ACT no matter what context you apply it in. If you have been asked to offer supervision or consultation to an ABA ACT practitioner, you may wish to use this rating form as a repeated measure from the beginning to the end of your relationship with trainees. When a trainee scores low on a competency, you may use exer­ cises in this book as a jumping-off point and then modify them as needed to create multiple exemplars with which to refine the learner’s ACT repertoire.

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ABA ACT Core Competency Rating Form RATING SCALE 1

2

3

4

5

6

7

?

Never true

Very seldom true

Seldom true

Sometimes true

Frequently true

Almost always true

Always true

Don’t know

WILLINGNESS 1

The BCBA communicates to clients that they are not broken but are using unworkable strategies.

2

The BCBA helps clients make direct contact with the paradoxical effects of emotion control strategies.

3

The BCBA actively uses the concept of workability in applied interventions.

4

The BCBA actively encourages the client to experiment with stopping the struggle for emotional control and suggests willingness as an alternative.

5

The BCBA highlights the contrast between the workability of control and willingness strategies.

6

The BCBA helps the client investigate the relationship between willingness and suffering.

7

The BCBA helps the client make contact with the cost of unwillingness relative to valued life directions.

8

The BCBA helps the client experience the qualities of willingness.

9

The BCBA uses exercises and metaphors to demonstrate willingness as an action in the presence of difficult internal experiences.

10

The BCBA models willingness in the therapeutic relationship and helps the client generalize these skills to other contexts.

11

The BCBA can use a graded and structured approach to willingness assignments.

The ABA ACT Core Competency Rating Form269

DEFUSION 12

The BCBA identifies the client’s emotional, cognitive, behavioral, or physical barriers.

13

The BCBA suggests that attachment to the literal meaning of these experiences makes getting unstuck difficult and slow.

14

The BCBA juxtaposes the client’s verbal statements about the way things ought to work with their experience of what does and does not work.

15

The BCBA uses metaphors and experiential exercises to help the client uncouple from their rigid verbal evaluations.

PRESENT MOMENT AWARENESS 16

The BCBA can defuse from client content and direct attention to the moment.

17

The BCBA brings their own thoughts or feelings in the moment into the therapeutic relationship.

18

The BCBA uses exercises to expand the client’s sense of experience as an ongoing process (e.g., mindfulness exercises or imagery exercises that support the client in focusing on the ongoing flow of internal experiences).

19

The BCBA detects when clients are drifting into a past or future orientation and teaches them how to come back to the present moment.

20

The BCBA practices and models getting out of their own mind and coming back to the present moment in session.

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FLEXIBLE PERSPECTIVE-TAKING 21

The BCBA uses metaphors and exercises to help clients distinguish between the content of their perspective and the ongoing action of taking perspective. The aim is to foster a sense of self as the field on which one performs roles, acts, and experiences life.

22

The BCBA uses metaphors and exercises to reduce clients’ attachment to conceptualized self or conceptualized others that create problematic rigidity or interfere with flexible responding.

23

The BCBA helps clients contact an expansive and interconnected sense of self through building a sense of being part of a larger whole that extends across time, place, and person, whether that be a group, humanity as a whole, or the continuity of consciousness itself.

24

The BCBA uses metaphors and experiential exercises to help the client uncouple from their rigid verbal evaluations.

VALUING 25

The BCBA helps the client clarify values-based life directions related to overt behavior slated for change.

26

The BCBA helps clients commit to what they want their life to stand for and focuses the therapy on this process.

27

The BCBA teaches the client to distinguish between values and goals.

28

The BCBA distinguishes between outcomes achieved and involvement in the process of living.

29

The BCBA states their own values and models their importance.

The ABA ACT Core Competency Rating Form271

COMMITTED ACTION 30

The BCBA helps the client identify values-based life goals and build an action plan linked to them.

31

The BCBA helps clients appreciate the qualities of committed action and take small steps while maintaining contact with those qualities.

32

The BCBA keeps clients focused on larger and larger patterns of action to help them act on goals with consistency over time.

33

The BCBA nonjudgmentally integrates client slips or relapses into the process of keeping commitments and building larger patterns of effective action.

Acknowledgments

No book is ever the product of its author’s labor in a vacuum. I stand on the shoulders of so many whose work challenged, coaxed, and shaped my own. In particular, I am indebted to Jeffrey Kupfer, my clinical mentor in Colorado who encouraged me to go to grad school, Larry Williams, my behavior analysis mentor at UNR who cheered me on as I delved into ACT, and Steve Hayes, who teamed me with senior students in the ACT-RFT lab to work together on ABA iterations of ACT. Over the years, my thinking has been further shaped by countless students and trainers. There are too many of you to list by name; you know who you are. Thank you for all you have given to me and the fields of contextual and applied behavior analysis.

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Thomas G. Szabo, PhD, BCBA-D, is a professor at Capella University’s master’s and doctoral behavior analysis programs; an internationally recognized acceptance and commitment therapy (ACT) trainer; a practicing board-certified behavior analyst (BCBA); and a graduate of the University of Nevada, Reno—where he studied under W. Larry Williams and Steven C. Hayes. Over the last decade, Szabo has focused his practice on teaching people ways to ignite behavioral and psychological flexibility in their personal lives and with others in clinical prac­ tice, schools, boardrooms, shop floors, and community centers. He is particularly interested in teaching people ways to use the psychological flexibility model to partner with autistic individu­ als and their families in the design and implementation of support strategies. With the Commit and Act Foundation in Sierra Leone West Africa, Szabo has trained therapists and couples to partner with kindness, and researched ways to reduce intrafamilial violence. With his students, Szabo investigates ACT training and applied relational frame theory (RFT). He has published empirical and conceptual papers, as well as several book chapters. Foreword writer Jonathan Tarbox, PhD, BCBA-D, is director of the master of science in applied behavior analysis program at the University of Southern California, as well as director of research at FirstSteps for Kids. He has published four books on autism treatment; is series editor of the Elsevier book series, Critical Specialties in Treating Autism and Other Behavioral Challenges; and has authored more than seventy peer-reviewed journal articles and chapters in scientific texts.

Index

A ABA. See applied behavior analysis ABA ACT Core Competency Rating Form, 267–271 abolishing operations (AOs), 54, 56, 57, 58–59, 60, 65 about this book, 2–4 acceptance (willingness), 119–149; ABA ACT Core Competency Rating Form, 268; in biflex modeling of ACT, 30; building exercises to facilitate, 130–135; core competency model responses, 143–149; core competency practice, 135–142; defined behaviorally, 26; functional assessment of deficits, 124–125; general approach to treating problems with, 125–127; importance of, 121–124; motivating operations underlying, 56; as typically discussed in ACT literature, 21–22; using ACT matrix to induce, 127–130; verbal tells, distinguishing, 45–46 acceptance and commitment therapy (ACT), vii–x; in ABA, vii–x, 1, 5, 265–266; ABA ACT Core Competency Rating Form, 267; about this book, 2–4; and BACB Task List, 259–261; biflex modeling of, 30; defined, 6–8, 256; learning, 69–76, 265–266; processes, 21–24; quadflex modeling of, 30, 31–32; radical behaviorism and functional contextu­ alism, 8–10; relational frame theory and, 15–19; repertoires, 26–33, 55–60, 267; research leading to, 10–14; scope of practice for behavior analysts using, 255–264; training in, 266, 267; triflex modeling of, 30, 31; when not to do in ABA, 37–41; when to use, 42–43. See also functional assessment and analysis accuracy of discrimination, emphasizing engagement over, 83–84 Aclan, M., 239 ACT matrix, 30, 77–89; basics, 69–73; connect­ ing assessment to treatment, 89; consider­ ations in using, 83–88; as distinguishing negative and positive reinforcement

contingencies, 77–78; introducing to clients, 79–83; as sharpening stimulus control, 78–79; using to engage others in the now, 173–175; using to facilitate committed action, 237–238; using to facilitate flexible perspective-taking, 202–204; using to facilitate valuing, 220–221; using to induce experiential willingness, 127–130; using to promote defusion, 156–157 action, in biflex modeling of ACT, 30. See also committed action action plan linked to goals, building, 244–245, 248 active exercises, 75–76, 111–118. See also physicalized metaphors adventure therapy, 75 aimless wandering: building exercises to facilitate committed action, 238–244; core competency model responses, 248–253; core competency practice, 244–247; defined behaviorally, 29; functional assessment of, 236; general approach to treating, 236–237; motivating operations underlying, 56; as typically discussed in ACT literature, 25; using ACT matrix to facilitate committed action, 237–238; verbal tells, distinguishing, 51–52 Akreyi, W., 233 allegory, enhancing metaphors through, 96–97, 108 allusion, enhancing metaphors through, 97, 108 Al-Nasser, T., 258 ambiguity, enhancing metaphors through, 97–98, 108 American Psychological Association (APA), 256 analog functional analysis strategies, 36 analogy: assessing relational framing repertoires, 62; enhancing metaphors through, 98, 108 answers, using ACT matrix to generate, 84–85 anxiety, as respondent behavior, 121 apostrophe, enhancing metaphors with, 98–99, 108 appetitive behavior, on ACT matrix, 77–78, 82–83

280

“Applause” (Lady Gaga), 92, 96 applied behavior analysis (ABA): about this book, 2–4; ACT in, vii–x, 1, 5, 265–266; challenge of providing services to clients, 119–121; current dimensions of, 258–259, 261–262; defined, 257–258, 259; importance of committed action in, 234–235; radical behaviorism and, 8–10; repertoires, 26–33, 55–60, 267; research leading to RFT and ACT, 10–14; research on using metaphors to influence behavior, 91–93; risk of overreach related to valuing, 219–220; scope of practice for using ACT in, 255–264; when not to do ACT in, 37–41; when to use ACT and when to stick to DCM strategies, 42–43. See also functional assessment and analysis approach behavior, 21–22, 26. See also acceptance arbitrarily applicable relational responding (AARR), 54 Arief, I., 92, 96 Aristotle, 91 assessment strategies, 1. See also ACT matrix; functional assessment and analysis Association for Contextual Behavior Science (ACBS), 256, 258, 265–266 Association of Professional Behavior Analysts (APBA), 257, 258 attachment to literal meaning of experiences, 162, 165 attention to the now, flexible, 169. See also present moment awareness augmentals, 28, 67–68, 260 autism, working with parents of children with, 123–124 aversive behavior, on ACT matrix, 77–78, 82–83 avoidance: in ACT, 21; defined behaviorally, 26; importance of willingness and, 121–122. See also experiential avoidance awareness of present moment. See present moment awareness away moves, 71, 85–86

B Baer, D. M., 258, 259, 261–262 Bailey, A., 239 Beasty, A., 12–13 behavior analysis. See applied behavior analysis; functional assessment and analysis

ACT and Applied Behavior Analysis

Behavior Analyst Certification Board (BACB): Ethics Code for Behavior Analysts, 257; Task List, 258, 259–261 behavior contracts, 238, 242–244 Behavior of Organisms, The (Skinner), 14 behavior skills training (BST) guided imagery, 133–135 behavioral barriers, identifying, 161, 164 behavioral momentum metaphor, 91–92 Bentall, R. P., 12–13 bidirectional relational terms in RFT, 18–19 biflex modeling of ACT, 30 blame, as sign of disconnectedness with present, 171–172 Bockarie, Hannah, 113 Bowl of Ice Exercise, 92 brief ACT functional analysis, ix, 53–60; example of, 64–65; kindness, vulnerability, and self-disclosure in, 60–61 Brownstein, A. J., 13

C Cast Away (film), 98 Catania, A. C., 13 catching metaphors in flight, 94–96 certification in ACT, 266 Cfunc in RFT, 16 children: with autism, working with parents of, 123–124; encountering complex emotions in, 262; functional assessment of willingness deficits, 124–125; introducing ACT matrix to, 80; relational framing with young, 66 choice point exercise, 238–242 Ciarrochi, J., 239 cliché, enhancing metaphors through, 99, 108 cognitive barriers, identifying, 161, 164 cognitive defusion. See defusion cognitive fusion. See fusion coherence: assessing essential, social, and functional, 66–67; in HDML assessment, 199; as molar CMO, 55, 57–58; self-related issues with, 200 combinatorially entailed relations in RFT, 18 committed action, 233–253; ABA ACT Core Competency Rating Form, 271; building exercises to facilitate, 238–244; core compe­ tency model responses, 248–253; core competency practice, 244–247; defined behaviorally, 29; functional assessment of deficits, 236; general approach to treating loss

Index281

of, 236–237; importance of, 234–235; motivating operations underlying, 56; for problems with experiential avoidance, 126–127; tethering values to, 220; as typically discussed in ACT literature, 25; using ACT matrix to facilitate, 237–238; verbal tells, distinguishing, 51–52 committment to values, helping client with, 226, 229 community psychology, 10 compassion, ix, 197–198, 262 competence, 3; as molar CMO, 56; when encountering emotional behavior, 262–263 competencies. See core competencies complexity, in HDML assessment, 199 compulsive perseverance, 235 conceptualized past and future: defined behav­ iorally, 27; detecting, and teaching to come back to present moment, 186, 191; functional assessment of, 171–172; preoccupation with, 169–170; as typically discussed in ACT literature, 23; verbal tells and reads, 46–48. See also present moment awareness conditional discrimination: ACT matrix as aid for, 79, 83; in BACB Task List, 260 conditionality, when assessing relational framing repertoires, 62–63 conditioned motivating operations (CMOs), 54, 55–56, 57–59 conditioning research leading to RFT and ACT, 11–12 confronting the system, 124 connection, as molar CMO, 55 content areas of BACB Task List, 259–261 context interventions: to enhance willingness, 149; involving metaphor, 74; as outcome of using ACT matrix, 85; for problems with experiential avoidance, 126–127 contextual sense of self, 194–195, 200 contextualist philosophy of science, 8–10 contingency contracts, 238, 242–244, 260–261 continuity strategy, 14 contrast, enhancing metaphors through, 95–96, 99, 108 control agenda, 120–121; actively encouraging client to experiment with stopping emotion control, 138, 145; drawing out, 125–126; exposing unworkability of, 126, 130; high­ lighting contrast between willingness

strategies and, 139, 145; paradoxical effects of emotion control strategies, 137, 144 controlling variables, environmental, 193–194 coordination, when assessing relational framing repertoires, 62 core competencies, 3; committed action model responses, 248–253; committed action practice, 244–247; defusion model responses, 164–167; defusion practice, 160–164; flexible perspective-taking model responses, 212–214; flexible perspective-taking practice, 208–211; present moment awareness model responses, 188–191; present moment awareness practice, 183–187; valuing model responses, 229–231; valuing practice, 225–228; willingness model responses, 143–149; willingness practice, 135–142 Core Competency Rating Form, 267 costs: of taking thoughts literally, 165; of unwillingness relative to valued life direc­ tions, 140, 146 covert behaviors: on ACT matrix, 70–71, 81–82; in radical behaviorism, 7–8 covert experiences, discriminating, 200 Crel in RFT, 16

D Dahl, J., 217 daily practice, using to engage others in the now, 178–180 DARE to Connect, 30, 31–32 Davis, M., 33 death, transitioning from euphemism when discussing, 100–102 defusion, 151–167; ABA ACT Core Competency Rating Form, 269; assessing essential, social, and functional coherence, 66–67; building exercises to facilitate, 157–160; from client content and directing attention to present moment, 183, 188; core competency model responses, 164–167; core competency practice, 160–164; defined behaviorally, 26–27; functional assessment of deficits, 154–155; general approach to treating problems with, 155–156; importance of, 153–154; motivating operations underlying, 55, 57–58; as typically discussed in ACT literature, 22–23; using ACT matrix to promote, 156–157; verbal tells, distinguishing, 44–45

282

deictic relations: assessing relational framing repertoires, 63–66; common empirically investigated relational frames, 17–18; deictic relational responding, 200; flexible and inflexible perspective-taking and, 28; hierarchical deictic framing, 195–197; and sharpened stimulus control with matrix work, 78–79; using ACT matrix to discover issues with, 204 delay discounting, 169, 235, 238–242 derivation, in HDML assessment, 199 descriptive functional assessments, 36 differential reinforcement, 6, 7, 151–152 difficult emotions: encountering using ACT, 262–263; working with parents experiencing, 123–124 difficult topics, euphemism when discussing, 99–102 dimensions of practice of ABA, 258–259, 261–262 direct communication, transitioning from euphemism to, 100–102 direct contingency functional behavior assess­ ment. See functional assessment and analysis direct contingency management (DCM): ACT as adjunct to, 7–8, 40–41, 258–259; commit­ ted action and, 235, 236–237; power of, 37–38; using ACT upon failure of, 38–39; when to stick to, 42–43; working with parents of children with autism, 123–124. See also context interventions direct experience avoidance, 45 disconnectedness with present, signs of, 171–172. See also conceptualized past and future; present moment awareness discrimination: ACT matrix as aid for, 79, 82–83, 85; in BACB Task List, 260; empha­ sizing engagement over accuracy of, 83–84; training exercises, 44 discriminative stimuli, interventions based on, 259–260 dismissiveness, as sign of experiential avoidance, 124–125 distinction, when assessing relational framing repertoires, 62 Dixon, M., 258

ACT and Applied Behavior Analysis

E emotion control strategies: actively encouraging client to experiment with stopping, 138, 145; paradoxical effects of, 137, 144 emotional barriers, identifying, 161, 164 emotions: challenges for ABA practitioners, 5; encountering emotional behavior using ACT, 262–263; labeling, 81–82; in the moment, bringing into therapeutic relationship, 184, 189; working with parents experiencing difficult, 123–124 engagement, emphasizing over accuracy of discrimination, 83–84 engagement in the now. See present moment awareness environmental controlling variables, 193–194 Epstein, R., 13–14 equivalence relations, 17 escape, 21, 26. See also experiential avoidance essential coherence, assessing, 66–67 establishing operations (EOs), 54, 56, 57, 58–59, 60, 65 Ethics Code for Behavior Analysts (BACB), 257 euphemism, enhancing metaphors through, 99–102, 108 evaluative framing, overextended, 88 everyday speech, metaphors in, 93–94 exercises: to facilitate committed action, 238–244; to facilitate defusion, 157–160, 164, 167; to facilitate flexible perspective-taking, 204–208, 209–210, 211–213, 214; to facilitate present moment awareness, 170, 175–182; to facilitate valuing, 221–224; to facilitate willingness, 126–127, 130–135, 141, 148 experiences: attachment to literal meaning of, 162, 165; revealing inconsistency between rules and, 163, 166 experiential avoidance: defined behaviorally, 26; functional assessment of, 124–125; general approach to treating, 125–127; importance of willingness, 121–122; modified choice point procedure, 238–242; motivating operations underlying, 56, 58–59; as typically discussed in ACT literature, 21–22; verbal tells, distinguishing, 45–46 experiential exercises: to facilitate defusion, 164, 167; to facilitate flexible perspective-taking, 211, 214

Index283

exposure exercise to facilitate willingness, 132–135 extinction: ACT matrix and, 79; differential reinforcement using alternatives to, 152; in relational frame theory, 16; verbal, 172

F feeling, as molar CMO, 56, 58–59 Feynman, R. P., 35 figurative language. See metaphors flexibility, in HDML assessment, 199 flexibility, psychological, 3, 6–7, 25, 30–32. See also acceptance and commitment therapy flexible attention to the now, 169. See also present moment awareness flexible perspective-taking, 193–214; ABA ACT Core Competency Rating Form, 270; building exercises to facilitate, 204–208; core compe­ tency model responses, 212–214; core competency practice, 208–211; defined behaviorally, 28; functional assessment of deficits, 198–200; general approach to treating deficits, 201; importance of, 194–198; motivating operations underlying, 55; as typically discussed in ACT literature, 23–24; using ACT matrix to facilitate, 202–204; verbal tells, distinguishing, 48–49 formist philosophy of science, 8–9 Free Tools page, 3 functional analytic psychotherapy (FAP), 9 functional assessment and analysis, ix, 35–68; in ABA, 35–37; brief ACT functional analysis, 53–61; of committed action deficits, 236; of defusion deficits, 154–155; of essential, social, and functional coherence, 66–67; of flexible perspective-taking deficits, 198–200; kind­ ness, importance of, 41–42; kindness, vulnerability, and self-disclosure, 60–61; metaphors and, 74; of plys, tracks, and augmentals, 67–68; of present moment deficits, 171–172; of relational framing repertoires, 61–66; of valuing deficits, 217–219; verbal tells, distinguishing, 43–53; when not to do ACT, 37–41; when to use ACT and when to stick to DCM, 42–43; of willingness deficits, 124–125 functional coherence, assessing, 66–67 functional contextualism, 10, 217–218 fusion: assessing essential, social, and functional coherence, 66–67; catching metaphors in

flight, 95–96; core competency model responses, 164–167; core competency practice, 160–164; defined behaviorally, 26–27; exercises to facilitate defusion, 157–160; functional assessment of, 154–155; general approach to treating problems with, 155–156; motivating operations underlying, 55, 57–58; overview, 151–153; as typically discussed in ACT literature, 22–23; using ACT matrix to promote defusion, 156–157; verbal tells, distinguishing, 44–45 future, conceptualized. See conceptualized past and future; present moment awareness

G generalizing willingness skills, 141, 148 Gilbert, Tom, 10–11 goals: distinguishing between values and, 227, 230; helping client act on with consistency over time, 246, 251; values-based, identifying and building action plan linked to, 244–245, 248 graded approach to willingness assignments, 142, 149 green, being, 265–266 Green, L., 239 Greenway, D. E., 13 grief, working with parents experiencing, 123–124 Groucho Marx Walk Exercise, 182 guided imagery: to facilitate willingness, 132–135; using to engage others in the now, 180–182

H Haas, J. R., 13 Hancock, H., 33 hard emotions: encountering using ACT, 262–263; working with parents experiencing, 123–124 hard topics, euphemism when discussing, 99–102 Harris, R., 239 Hayes, S. C., 3, 8, 9, 10, 13, 55, 73, 135, 217, 258, 267 hexaflex, 25, 30. See also repertoires hierarchical framing: assessing relational framing repertoires, 63; deictic, 195–197; and sharp­ ened stimulus control with matrix work, 79 high-probability command sequence, 91–92

284

hot learning, 32 Hutter, E., 92, 96 hyperbole, enhancing metaphors through, 102, 108 hyper-dimensional multilevel framework (HDML), 198–199

I if-then relations, 61–62 I-in-context, 63–65 inconsistency between rules and experience, revealing, 163, 166 indirect contingency management, 258–259. See also acceptance and commitment therapy indirect functional assessments, 36 inflexible perspective-taking: building exercises to facilitate flexibility, 204–208; core competency model responses, 212–214; core competency practice, 208–211; defined behaviorally, 28; functional assessment of, 198–200; general approach to treating, 201; motivating operations underlying, 55; as typically discussed in ACT literature, 23–24; using ACT matrix to facilitate flexibility, 202–204; verbal tells, distinguishing, 48–49 initiating agent concept of self, 193–194 Inside Out (film), 97 instructions, in BACB Task List, 260 interventions: ACT matrix as tool for, 89; in BACB Task List, 259–260; identifying targets related to flexible perspective-taking, 199–200, 201; strategies described in this volume, 1. See also exercises; functional assessment and analysis; metaphors irony, enhancing metaphors through, 103, 108

J jargon, avoiding, 81 Journal of Applied Behavior Analysis, 10

K Kabat-Zinn, J., 23 Kermit the Frog, 265, 266 kindness, in functional assessment and analysis, 41–42, 60–61 Kupfer, Jeff, 265

L Lady Gaga, 92, 96

ACT and Applied Behavior Analysis

Lanza, R. P., 13–14 larger whole, building sense of being part of, 210, 213 Law, S., 258 learning ACT, 69–76, 265–266; ACT matrix and, 69–73; active exercises and, 75–76; metaphors and, 73–74 Learning ACT (Luoma, Hayes, and Walser), 3 literal meaning of experiences, attachment to, 162, 165 literary devices to enhance metaphors: allegory, 96–97, 108; allusion, 97, 108; ambiguity, 97–98, 108; analogy, 98, 108; apostrophe, 98–99, 108; cliché, 99, 108; contrast, 99, 108; euphemism, 99–102, 108; hyperbole, 102, 108; irony, 103, 108; metonymy, 103–104, 109; overview, 96, 108–109; oxymoron, 104, 109; paradox, 104–105, 109; personification, 105–106, 109; pun, 106, 109; symbols, 106–107, 109; synecdoche, 107, 109 living, distinguishing involvement in process of, 228, 231 loss of committed action. See aimless wandering loss of contact with present moment. See conceptualized past and future; present moment awareness loss of contact with values: assessing essential, social, and functional coherence, 66–67; assessing plys, tracks, and augmentals, 67–68; building exercises to facilitate valuing, 221–224; core competency model responses, 229–231; core competency practice, 225–228; defined behaviorally, 28–29; functional assessment of, 217–219; general approach to treating, 219–220; motivating operations underlying, 56; as typically discussed in ACT literature, 24; verbal tells, distinguishing, 50–51 Lowe, C. F., 12–13 Luciano, C., 217 Luoma, J. B., 3, 135, 267

M maintenance, in BACB Task List, 261 Matthews, B. A., 13 McCurry, S. M., 73 McHugh, L., 199 meaning in verbal behavior, 43 mechanist philosophy of science, 8–9 meditation. See also guided imagery

Index285

metaphors, 2, 16, 91–109; active exercises and, 75–76; basics, 73–74; catching in flight, 94–96; common in speech, 93–94; to engage others in the now, 175–180, 221–223; to engage others with flexible perspective-tak­ ing, 204–205, 209–210, 211–213, 214; exercises to facilitate defusion, 158–159, 164, 167; to induce experiential willingness, 128–130; literary devices to enhance, 96–109; research on using to influence behavior, 91–93; using to induce experiential willing­ ness, 141, 148. See also physicalized metaphors metonymy, enhancing metaphors through, 103–104, 109 Michael, J., 54, 55 middle-level terms, 21 mindfulness, 23. See also present moment awareness Mo’ Better Blues (film), 23 Model Behavior Analyst Licensure Act (APBA), 257 modeling: getting out of mind and returning to present, 187, 191; importance of values, 228, 231; willingness in therapeutic relationship, 141, 148 modified choice point procedure, 238–242, 246, 249–250 molar CMOs, 55–56, 57–59 moment, awareness of. See present moment awareness momentum metaphor, 91–92 motivating operations (MOs), 36, 54–59, 259–260 Murrell, A. R., 224 mutually entailed relations in RFT, 18

N negative reinforcement: ACT matrix as distin­ guishing, 77–78; in BACB Task List, 259 negatively reinforced behaviors: on ACT matrix, 70, 71, 77–78; away moves vs. toward moves, 85–86 New Harbinger website, 44 nonpunishing audience, 61, 87 now, flexible attention to the, 169. See also present moment awareness

O ongoing flow of internal experiences, expanding client sense of, 185, 190 operant conditioning, 11–12 oppositional framing: assessing relational framing repertoires, 62; when introducing ACT matrix to clients, 82–83 organicist philosophy of science, 8–9 other-as-content, 197–198 other-as-context, 197–198 other-as-process, 197–198 outcomes, distinguishing between involvement in process of living and, 228, 231 outdoor adventure therapy, 75 overt behavior: on ACT matrix, 70, 71–72; in BACB Task List, 259; clarifying values-based life directions related to, 225, 229; introduc­ ing ACT matrix to clients, 82; in radical behaviorism, 7–8 overt experiences, discriminating, 200 oxymoron, enhancing metaphors through, 104, 109

P painful topics, euphemism when discussing, 99–102 Palinski, C. J., 92 paradox, enhancing metaphors through, 104–105, 109 paradoxical effects of emotion control strategies, 137, 144 parents of children with autism, working with, 123–124 past, conceptualized. See conceptualized past and future; present moment awareness patterns of action, keeping client focused on larger, 246, 251 peer-review process, 266, 267 Pepper, S. C., 8, 9 perfectionism, extremes of, 234–235 perseverance, 235 personification, enhancing metaphors through, 105–106, 109 perspective-taking. See flexible perspectivetaking; inflexible perspective-taking philosophy of science, 8–10 physical barriers, identifying, 161, 164 physicalized metaphors: behavior analytic approach to, 111–118; to engage others in the

286

now, 175–180; enhancing behavioral impact of metaphors with, 75–76; to facilitate defusion, 159–160; to facilitate flexible perspective-taking, 205–208; to facilitate willingness, 129–130, 131–132; research on using to influence behavior, 92 Plato, 9 plys, assessing, 67–68 Polk, K. L., 69 positive reinforcement: ACT matrix as distin­ guishing, 77–78; in BACB Task List, 259 positively reinforced behaviors: on ACT matrix, 70, 71, 72, 77–78; away moves vs. toward moves, 85–86 practicing: getting out of mind and returning to present, 187, 191; physicalized metaphors, 112–114 practitioners, emotional challenges for, 5 preoccupation with conceptualized past or future. See conceptualized past and future prepackaged materials, 2 presence, as molar CMO, 56 present moment awareness, 169–191; ABA ACT Core Competency Rating Form, 269; building exercises to facilitate, 175–182; core compe­ tency model responses, 188–191; core competency practice, 183–187; defined behaviorally, 27; functional assessment of deficits, 171–172; general approach to treating deficits, 172; importance of, 169–170; motivating operations underlying, 56; as typically discussed in ACT literature, 23; using ACT matrix to enhance, 173–175; verbal tells, distinguishing, 46–48 problem-solving, using ACT matrix for, 84–85 process interventions: to enhance willingness, 126–127, 149; involving metaphor, 74; as outcome of using ACT matrix, 85 process of living, distinguishing involvement in, 228, 231 processes in ACT, 21–25 procrastination, 234, 235 psychological flexibility, 3, 6–7, 25, 30–32. See also acceptance and commitment therapy psychotherapy: defined, 256; encountering emotional behavior in, 262; and scope of practice for behavior analysts using ACT, 255, 257–258 pun, enhancing metaphors through, 106, 109 purpose, as molar CMO, 56

ACT and Applied Behavior Analysis

Q quadflex modeling of ACT, 30, 31–32 qualities: of committed action, appreciating and maintaining contact with, 246, 249; of willingness, helping client experience, 140, 147

R Rachlin, H., 239 radical behaviorism, 7–10 reads, verbal. See verbal tells and reads Reese, H., 8 reflexivity, 18 reinforcement: associated with conceptualized past and future, 171–172; in BACB Task List, 259; in exercises to facilitate willingness, 131, 135; insensitivity of rule-governed behavior to schedules of, 12–13; metaphors related to, 91–92; negative, 77–78, 259; overt and covert behavior in radical behaviorism, 7–8; positive, 77–78, 259 relapses, integrating into committed action work, 247, 252–253 relata, in RFT, 16 relational frame theory (RFT): assessing relational framing repertoires, 61–66; basic findings of, 15–17; bidirectional relational terms, 18–19; common empirically investi­ gated relational frames, 17–18; metaphors and, 73; research leading to, 10–14; selfing, 194–197, 198–199; sharpened stimulus control with matrix work and, 78–79 repertoires, 26–33; ABA ACT Core Competency Rating Form, 267; in behavior analytic terms, 26–29; mistakes related to, 32–33; motivating operations underlying, 55–60; redux, 29–32. See also functional assessment and analysis replacement behaviors, 82–83 Republic, The (Plato), 9 research: leading to RFT and ACT, 10–14; on using metaphors to influence behavior, 91–93 respondent conditioning, 11–12 rigid perspective-taking. See inflexible perspective-taking Risley, T. R., 258, 259 rule-governed behavior, schedule insensitivity of, 12–13 rules: in BACB Task List, 260; functional assessment of, 66–68; revealing inconsistency

Index287

between experience and, 163, 166. See also defusion; fusion; valuing

S Sagvolden, T., 13 schedule insensitivity, 12–13 Schoendorff, B., 69 science, philosophy of, 8–10 Science and Human Behavior (Skinner), 22, 193–194 scope of practice for behavior analysts using ACT, 255–264; BACB Task List, 258, 259–261; current dimensions of ABA, 258–259, 261–262; defining ABA, 257–258; defining ACT, 256; defining psychotherapy, 256; encountering emotional behavior, 262–263; general discussion, 263–264 selection metaphor, 91 self-as-content, 23–24, 195–196 self-as-context, 23–24, 28, 49, 63–65, 196–197 self-as-process, 23–24, 196 self-compassion, 197, 198 self-control, 193, 239–242 self-disclosure in functional assessment, 60–61 selfing: functional assessment of, 198–199; overview, 194–197. See also flexible perspec­ tive-taking; inflexible perspective-taking self-knowledge, 78–79, 193–194 self-management strategies, in BACB Task List, 261 self-monitoring, in exercises to facilitate willing­ ness, 131–132, 135 self-related coherence issues, 200 shame, selfing issues as connected to, 201 shaping agenda, 120–121 Shimoff, E., 13 Sidman, M., 11, 12, 13 simple discriminations, in BACB Task List, 260 situationally aware behavior. See present moment awareness Skinner, B. F., 13–14, 17, 22, 29, 43, 55, 64, 78, 91, 103, 121, 193–194, 216, 217 slips, integrating into committed action work, 247, 252–253 small steps, helping clients take, 246, 249–250 SMART goals, 236–237, 244, 246, 251 social coherence, assessing, 66–67 socially significant overt behavior, in BACB Task List, 259 solutions, using ACT matrix to generate, 84–85

“Some Current Dimensions of Applied Behavior Analysis” (Baer et al.), 261–262 sorrow, working with parents experiencing, 123–124 space, in hierarchical deictic framing, 195 Spaces in Between Exercise, 171 spatial relations, when assessing relational framing repertoires, 63 speech, common metaphors in, 93–94 standing at a crossroads metaphor, 89, 93 Stanley, C. R., 258 stimulus control, ACT matrix as sharpening, 78–79. See also present moment awareness stimulus equivalence, 11, 13 stimulus function, transformation of, 18–19 strengthening metaphor, 91 structured approach to willingness assignments, 142, 149 structured practice, for problems with experien­ tial avoidance, 126–127 Stumbling About exercise, 178 successful operants, 82–83 suffering, investigating relationship between willingness and, 139, 146 symbols, enhancing metaphors through, 106–107, 109 symmetry, 11, 18 synecdoche, enhancing metaphors through, 107, 109 Szabo, T. G., vii–ix, 1, 3–4, 92, 239

T Tarbox, J. J., vii, 239, 258 Task List, BACB, 258, 259–261 tells. See verbal tells and reads temporal aspects of stimulus control, 169–170 temporal relations, when assessing relational framing repertoires, 63 therapeutic alliance/relationship: bringing thoughts and emotions in the moment into, 184, 189; modeling willingness in, 141, 148; training behavior analysts in, 262; validation and, 86–88 thoughts: in the moment, bringing into thera­ peutic relationship, 184, 189; suppression strategies, 122. See also defusion; fusion time, in hierarchical deictic framing, 195 tools, ACT, viii–ix, 3 toward moves, 72, 85–86 tracks, assessing, 67–68

288

training: in ACT, 266, 267; for encountering emotional behavior, 262–263 transformation of stimulus function, 18–19 transitivity, 11, 18 trauma-informed care, training in, 262 treatment, connecting assessment to, 89 triflex modeling of ACT, 30, 31 trigger analysis, 36 trivializing statements, as sign of experiential avoidance, 124–125

U unfocused action. See aimless wandering unwillingness, cost of relative to valued life directions, 140, 146 unworkable strategies: communicating to clients about, 137, 143; exposing when treating experiential avoidance, 126

V validation, 86–88 valued life directions, cost of unwillingness relative to, 140, 146 values: on ACT matrix, 70, 71, 80, 220; commit­ ted action and, 236, 244–245; defined, 217 valuing, 215–231; ABA ACT Core Competency Rating Form, 270; ACT as adjunct to DCM, 40–41; assessing essential, social, and functional coherence, 66–67; assessing plys, tracks, and augmentals, 67–68; building exercises to facilitate, 221–224; core compe­ tency model responses, 229–231; core competency practice, 225–228; defined behaviorally, 28–29; functional assessment of deficits, 217–219; general approach to treating deficits, 219–220; importance of, 216; motivating operations underlying, 56; as typically discussed in ACT literature, 24; using ACT matrix to facilitate, 220–221; verbal tells, distinguishing, 50–51 verbal behavior: and behavior on schedules of reinforcement, 12–13; instruction for persons with intellectual challenges, 11; meaning in, 43; relational frame theory, 15; Skinner’s definition of, 13–14 verbal conditioned motivating operations, 260

ACT and Applied Behavior Analysis

verbal exposure exercise to facilitate willingness, 132–135 verbal extinction strategy, 172 verbal tells and reads, 43–53; aimless behavior vs. committed action, 51–52; discrimination training, 44; experiential avoidance vs. willingness, 45–46; fusion vs. defusion, 44–45; inflexible vs. flexible perspectivetaking, 48–49; limits of topographical information, 53; loss of contact with present moment vs. present moment awareness, 46–48; loss of contact with values vs. valuing, 50–51. See also functional assessment and analysis vulnerability, in functional assessment, 60–61

W Walser, R. D., 3, 135, 267 whole, building sense of being part of larger, 210, 213 willingness (acceptance), 119–149; ABA ACT Core Competency Rating Form, 268; in biflex modeling of ACT, 30; building exercises to facilitate, 130–135; core competency model responses, 143–149; core competency practice, 135–142; defined behaviorally, 26; functional assessment of deficits, 124–125; general approach to treating problems with, 125–127; importance of, 121–124; motivating operations underlying, 56; as typically discussed in ACT literature, 21–22; using ACT matrix to induce, 127–130; verbal tells, distinguishing, 45–46 Willis, P. B., 92 Wilson, K. G., 217, 224 Witts, B. N., 92, 96 Wolf, M. M., 258, 259 workability: active use of concept in applied interventions, 136, 138, 144; contrast between control and willingness strategies, 139, 145 World Hypotheses (Pepper), 8, 9

Y yearnings, 55–60 young children, relational framing with, 66. See also children

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As a board-certified behavior analyst (BCBA or BCaBA), your clients have a wide range of language skills—from nonspeaking to very fluent. To ensure the best behavior outcomes, you need a flexible therapeutic framework to fully engage with all clients—as well as their families. This comprehensive professional guide offers a proven-effective program grounded in acceptance and commitment therapy (ACT) and relational frame theory (RFT) to help you expand the effectiveness of your practice and deliver exceptional care.

With ACT and Applied Behavior Analysis, you’ll learn to conceptualize your cases using ACT, create your own client exercises, generate metaphors, and be fully present with each unique client. By integrating core ACT skills—including mindfulness, flexible perspective taking, committed action, and values work—you’ll be ready to take your applied behavior analysis (ABA) practice to the next level. You’ll also find information on cultural competency and diversity to further broaden the scope and effectiveness of therapy. If you’re looking for skills and strategies to enhance your ABA practice, this book has everything you need to get started.

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ACT and Applied Behavior Analysis

A Comprehensive Guide to Using ACT in Applied Behavior Analysis

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A Practical Guide to Ensuring Better Behavior Outcomes Using Acceptance and Commitment Training

ACT and Applied

Behavior Analysis • Explore the roots of ACT • Create client-specific exercises and metaphors

Thomas G. Szabo, PhD, BCBA-D, is a professor at Capella University’s ACT trainer, and a board-certified behavior analyst.

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