CALO relative to Behavior Modification         

Behavior Modification is the standard model in most Residential Treatment Centers (RTCs). Behavior Modification has its foundation in the work of B.F. Skinner. Skinner passed away in 1990 after revolutionizing the way the world looks at learned behavior. Terms from his work such as operant conditioning, conditioned responses, and positive and negative reinforcement have become a part of our normal daily vocabulary. Stated summarily, Skinner’s model of human behavior posits that people move toward positive stimuli (food, praise, reward) and away from aversive stimuli (punishment, pain). Using that knowledge, human behavior can therefore be controlled by anyone in control of reward and punishment.

Behavior Modification became the controlling model as residential treatment was born. Student “structure” was and is emphasized. Conformity and accountability were prized and sought after.

Most RTCs don’t like to admit they are Behavior Mod but there are tell-tale signs that will give them away consistently. One is the presence of any form of level system. Another would be points for behavior. Reward systems and any concept of “earning” status or activities or rewards would also highlight a Behavior Mod philosophy.

It should be noted that there is great power in Behavior Mod interventions for a variety of behavioral problems evidenced by adolescents. Oppositional Defiant Disorder responds well to Behavior Mod. So does ADHD, true Conduct Disorder, poor peer relationships, entitlement issues, and issues that have at their genesis ineffective parenting skills. The immediacy and consistency of Behavior Mod approaches create change in these kids.

Where Behavior Mod does not work is around issues that have trauma, in various forms, at their genesis. Reactive Attachment Disorder and other attachment difficulties, PTSD, as well as many issues of affect regulation, do not respond well in the long-term to Behavior Mod. One of the reasons for this is that Behavior Mod mimics the trauma that helped create the difficulties in the first place. Many past traumas are extreme instances of Behavior Mod. We can best explain this from a real life example.

We worked with a young girl we will call Maddy. Maddy came from China where she had spent her first five years of life in an orphanage. As part of their management of the children the orphanage required silence from the children. When children were noisy they were tied wrist and ankle to a high chair for the day. Maddy had scars on her wrists and ankles from being tied for days to a chair. What Maddy had endured was extreme, abnormal, abusive Behavior Modification. As Maddy was adopted here in the U.S. she began to act out in Reactive Attachment ways. As she grew older she was self-injurious and sexually promiscuous. As an adolescent, Maddy’s adoptive parents put her in residential treatment at a reputable program. Unfortunately, anything that had a Behavior Mod flair only felt like continued abuse for Maddy. Maddy slipped right into her earlier-life defense strategies, namely, play the system intelligently and survive. Maddy had learned to fake good and conform for whatever needed amount of time in order to escape and return to her friends and self destructive behavior. Behavior Mod had the net effect of forcing Maddy underground. Her behavior was conforming and survivalist but her heart and attachment issues were unchanged.

In contrast to this Behavior Mod approach is what we do at CALO. Whereas in most RTCs fairness is getting what you earn, at CALO we are guided by an overarching philosophy of: fairness is getting what you need. Phone calls home are not earned, they are immediate because students need that contact to heal. Recreation therapy activities are provided to a student new to the program, just as they would be for one who has been with us for a year. Students do not need to “achieve” a certain level to participate. Confrontation is not embraced but attunement to a student’s emotional state is. Structure is not emphasized but rhythms are. Rules are not the norm, just an overriding concern for safety and whatever a student NEEDS for their progress.