Invited Article

Research on Social Work Practice

23(2) 121-140
Birds of a Feather: Applied Behavior ª The Author(s) 2012
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Analysis and Quality of Life DOI: 10.1177/1049731512465775
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Eileen Gambrill1

Abstract
Applied behavior analysts have been helping people to enhance the quality of their lives for decades. Its characteristics as
described by Baer, Wolf, and Risley continue to guide efforts to help clients and their significant others. Yet, this knowledge often
languishes unused and unappreciated. Distortions and misrepresentations of applied behavior analysis and radical behaviorism
abound. Applied behavior analysis (ABA) is contextual and concerned with social validity—with the views of clients and significant
others regarding outcomes. These characteristics make it radical in shedding light on dysfunctional contingencies some may wish
to remain hidden. Given that ABA and quality of life are birds of a feather, we must become more successful in highlighting this
close relationship as a route to increased dissemination of effective methods. Obstacles are suggested as well as a path for
accomplishing this, including making avoidable suffering due to failure to use effective methods more visible.

Keywords
prevention, social justice, evidence-based practice, applied behavior analysis, behavioral assessment

It is an honor and opportunity to be invited to give the first Don characteristics of applied behavior analysis (ABA). Together
Baer lecture at this conference. The greatest gift of this invita- with his colleagues Montrose Wolfe and Todd Risley, Don
tion is the opportunity to luxuriate in the clarity of Don’s think- Baer wrote ‘‘Some current dimensions of applied behavior
ing, his openness to ideas and total presence. No one has analysis’’ published in 1968 and a follow-up article in 1987.
described Don better than his wife, Dr. Elsie Pinkston, Profes- Their 1987 article ‘‘Some still-current dimensions of applied
sor Emeritus, School of Social Service Administration, Univer- behavior analysis’’ is both a description of what ABA is and
sity of Chicago, through whom I met Don. Following Don’s a discussion of its possible future.
untimely loss, Ivor Lovaas asked Elsie to write a book about
Don.1 By such books, perhaps people hope to learn unknown
things about a person of interest. Instead of a book, Elsie ABA
offered a poem entitled ‘‘Is It Fair?’’ Her last lines in this poem ABA is a scientific approach to the study of behavior paying
capture Don’s essence careful attention to the social validity of concerns addressed
and related outcomes (Wolf, 1978). This applies to clients as
There really are few unknown things to tell. well as to their significant others, those who influence clients
He was the man that he appeared to be; and who may be affected by interventions. Key characteristics
What you saw was what you got, of ABA include attention to context (environmental) influences
And there was a lot to see. and constructing repertoires building on those clients and sig-
nificant others already possess. ABA is based on the findings
Striking to me about Don Baer was his total presence when from the experimental analysis of behavior—a scientific
you were with him, whether in person or as a reader of his approach to behavior in which we try to identify the variables
prose, and his intense curiosity about life, especially behavior that influence behaviors of concern (conduct a descriptive anal-
and how to change it. Many have remarked on the clarity of ysis) and then vary these to determine if we are correct in our
Don’s prose. Indeed, in remembrances to Don, his skill with guesses (conduct a functional analysis). In this way, we can
words are highlighted; he had a sign on his office door—
‘‘Wordsmith.’’ This clarity enabled ideas about how to explore
1
the controlling conditions of behaviors in experiment after University of California, Berkeley, CA, USA
experiment, with students and colleagues over his long produc-
Corresponding Author:
tive career. Don was a pristine wordsmith, one who avoided all Eileen Gambrill, School of Social Welfare, Haviland Hall, University of
kinds of distracting, misleading, confusing prose. He was California at Berkeley, Berkeley, CA 94720, USA.
exceptionally clear analytically, modeling one of the key Email: [email protected]
122 Research on Social Work Practice 23(2)

find out which of our guesses are wrong. Consider the assump- different areas including behavioral medicine, organizational
tion that sensory integration therapy (brushing and joint com- change, school wide programs, behavioral sports, and treat-
pression) is effective in decreasing aggressive behavior of a ment of depression. Baer and his colleagues (1987) suggest that
nonverbal 8-year-old boy with autism. The occupational ‘‘Perhaps the clearest measure of our discipline’s effectiveness
therapist at the child’s school recommended this intervention. is the increased number of ineffective applications that we have
Investigation within a single-case design showed that this inter- tried in recent years’’ (p. 323). As they note, ‘‘failures teach’’
vention actually increased hitting episodes, a negative outcome (p. 325).
(Kay & Vyse, 2005). Applications range from the simple (e.g.,
Allday, Bush, Ticknor, &Walker, 2011; Singer-Dudek, Oblak,
Analytic and Conceptual
& Greer, 2011) to the complex (e.g., Sailor, Dunlap, Sugai, &
Horner, 2009). Baer et al. (1987) combine analytic and conceptual in their dis-
cussion of dimensions of ABA. They describe a contextual
(systemic) approach to behavior change in which ‘‘we change
Applied the much more frequent behaviors that we suppose are precur-
sors to behaviors of interest’’ (p. 317). (See also Goldiamond,
In their article ‘‘Some still-current dimensions of applied beha- 1974, 1984.)
vior analysis,’’ Baer, Wolf, and Risely (1987) describe applied
as referring to ‘‘at least behaviors of a person called subject or A nonlinear approach involves analysis of (a) the contingency
client that trouble that person; but more often, they are also of which the target behavior is a member (the direct or linear
behaviors of people other than the one called subject or client’’ relations); (b) alternative sets, or matrices, of consequential
(p. 314). They suggested that ‘‘Social problems are those beha- contingencies, of which the target behavior and currently avail-
viors of the subject or client that result in counterreaction, able alternative patterns are members; and (c) the contingencies
sometimes by the client, but more often by nonclients, suffi- or relations that can potentiate the matrices (the nonlinear rela-
cient to generate something called a solution, or at least a pro- tions). This analysis is applied to gain an understanding of the
gram’’ (p. 314). Thus, ‘‘social problems are essentially the patterns of observed learner behavior, which occur as a result of
behaviors of displaying or explaining problems—one’s own the interaction of these matrices. (Twyman, Layng, Stike-
or someone else’s’’ (p. 314). Such displays may be very indi- leather, & Hobbins, 2005, p. 62)
vidual (a personal problem) or very broad (referred to as a
social problem). Behavior analysts have contributed to the Something may work even though the analysis is faulty (Mor-
understanding of cultural and behavioral change, including ris, 1980). Many practices in medicine work but we do not
organizational change (e.g., Biglan, 1995, 2009; Daniels, know why they work; there is a failure of analysis but not a fail-
2000; Mattaini, 2003). Malott and Glenn (2006) suggest that ure of effects. ‘‘Applied behavior analysis is more often consid-
a cultural problem occurs when a ‘‘condition causing dissatis- ered an analytic discipline only when it demonstrates
faction or threat is the aggregate product of the behavior of convincingly how to make specified behavior changes and
many people.’’ when its behavior-change methods make systematic, concep-
Behavioral is a second key dimension of ABA. Measure- tual sense’’ (p. 318). Baer (1991) suggested that ‘‘radical beha-
ment of behavior involves ‘‘the direct observation and record- viorism recommends reserving merely conceptual control only
ing of a subject’s target behaviors by an observer under the for those behaviors not amenable to experimental control’’ (pp.
stimulus control of a written behavior code’’ (p. 316). Baer and 430–431).
his coauthors (1987) note the enormous interest in behavioral
theory and technology. Technological
One mark of the success of applied behavior analysis in the last The technological aspect of ABA refers to the fact that it can be
two decades is that its practitioners, researchers, and theorists replicated and effects consistently found. Baer and his col-
have encountered so many invitations to become something leagues (1987) note the need for flexibility to consider unique
other than behavioral, in the form of becoming something individual differences in preferences for certain procedures.
‘‘more’’ than behavioral. In particular, their occasional main-
streaming with behavior therapy, education, developmental Capable of Appropriate Generalized Outcomes
psychology, psycholinguistics and sociobiology has given them
the chance to entertain constructs of attention, intelligence, dis- Generalization over individuals, settings, and time (mainte-
abilities, spontaneity, readiness, critical period, innate releasers, nance) is of key interest. It is often easy to get people to change
storage and retrieval mechanisms, schemata and the like. (p. 315) their behavior initially such as altering eating patterns and exer-
cising; maintaining these changes is another matter. Do desired
They suggest that ‘‘the most fruitful task, however, is to recog- changes occur in other settings? Do changes influence other
nize that each of those labels (and many others like them) often behaviors, including those tangentially related to training set-
represents some behavioral reality not yet analyzed as such’’ tings as when learning a problem-solving skill? In ABA, plan-
(p. 315). Behavioral methods continue to be applied to many ning for the generalization and maintenance of behaviors of
Gambrill 123

value to clients and their significant others is a key component principles and related theory. Dissemination and diffusion of
of intervention. Attention to generalization and maintenance is valuable programs are of concern in all areas including ABA
indeed one of the great contributions of ABA (e.g., see Gianou- (e.g., Fixsen, Blase, Naoom, & Wallace, 2009; Paine & Bel-
mis & Sturmey, 2012). Many programs have a ‘‘train and hope lamy, 1982). Literature in ABA describes creative applications
approach’’; they train someone and hope it generalizes or is of findings from the experimental science of behavior includ-
maintained over time. Baer and his colleagues (1987) also dis- ing building on alternative repertoires to decrease concerns
cuss generalization in relation to ABA itself. such as hallucinations and binge eating (Budd & Stokes,
2003; Goldiamond, 1984; Layng, 2009). If a child cannot
Effectiveness speak, develop a picture book that illustrates different kinds
of reinforcers and the child can point to them. If older people
Social validity is of great concern. Do the consumers of an fall asleep during a movie and then awake when the movie is
intervention like its goals, targets, effects, procedures, and per- half over and are thus uninterested, set up a system whereby
sonnel? Wolf (1978) suggested that social validity applies to if a button is not pressed every few minutes, the movie stops
(1) the significance of behavioral goals, (2) the appropriateness so that if the person falls asleep, when they awake they will
of behavioral procedures, and (3) the importance of behavioral only have missed a few minutes and retain their interest in
effects. Goals, procedures, and effects should be carefully vali- ‘‘what happens next’’ (Lindsley, 1964). If conversation is lack-
dated in terms of their acceptability to clients and significant ing around a table in a retirement home, serve food family style
others. Without attention to social validity of this kind, pro- rather than on individual plates to increase conversation. (See
grams that can improve quality of life may not be implemented also McClannahan & Risley, 1975.) If teachers are unwilling
or disseminated. Scholars in the area of ABA have contributed to change their behavior in order to be more positive with chil-
to a valuable literature regarding acceptability of goals, proce- dren in their classroom, teach children how to alter the behavior
dures, and their effects. Use of social-validity measures aids in of teachers (Graubard, Rosenberg, & Miller, 1971). If learning
minimizing rejection of an intervention. ‘‘Giving consumers is boring, make it game-like (e.g., see Donaldson, Vollmer,
any opportunity to express complaints and discontents that oth- Krous, Downs, & Berard, 2011). The APA Handbook of Beha-
erwise would go unnoticed may save at least some programs vior Analysis (Madden, 2012) describes applications in envi-
from fatal backlashes, at least if the offended consumer is ronmental health, treatment of autism, attention-deficit/
moved enough by simply the existence of the otherwise inade- hyperactivity disorder (ADHD), teaching, substance abuse,
quate social-validity assessment form to write in its margins or industrial problems and business, and sleep problems. Beha-
talk to the appliers’’ (Baer, Wolf, & Risley, 1987, p. 323). (See vioral principles are drawn on to address self-injurious beha-
also Baer, 2004.) As Baer et al. (1987) note, ‘‘the hallmark of vior, behavior related to a wide range of health concerns
effectiveness may be subtle: sometimes, it seems to be simply (e.g., smoking, weight, and drinking), parent–child interaction,
the degree to which the target behavior has been changed; and a range of behaviors in educational settings. They are cen-
much more often, it is the degree to which something other than tral in working with children and children and adults with
the target behavior has been changed and that something other developmental disabilities, in dialectical behavior therapy
almost invariably is someone’s countercontrol against the orig- (Linehan, 1993) and acceptance and commitment therapy
inal behavior’’ (p. 322). ‘‘Almost every successful study of (Hayes, Strosahl, & Wilson, 2012). They are used to improve
behavior change ought to routinely present two outcomes—a conditions in organizations and communities (e.g., see Free-
measure of the changed target behaviors, of course, and a mea- man et al., 2010).
sure of the problem displays and explanations that have stopped However, ABA and related theory often remain underused
or diminished in consequence. Yet very few studies do that’’ (p. or unused in areas in which they could minimize avoidable mis-
322). They suggest that even though a program may not solve a eries and increase quality of life as many have noted (e.g., Mal-
problem, it may nevertheless be valuable because it may ‘‘solve ott, 1996; Morris, 1985; Thyer, 2005). Consider this quote from
the sometimes more aversive problem of doing nothing about Don Baer in 2002:
that problem’’ (p. 314) or may solve an important related prob-
lem. For example, an application may allow the client or coun- I note that behavior analysis and applied behavior analysis have
teracting nonclients to discuss the problem. Indeed, they been very small, heavily criticized, and despised disciplines;
suggest that there may be no such thing as a totally ineffective I expect that will continue, largely because proof-dependent
program. Thus, even though problems are not solved, interven- natural-science views of human behavior are both threatening
tions may have some social validity. Could this be why many to their competitors and also very poor show business. I expect
‘‘ineffective’’ programs exist? that the powerful techniques of applied behavior analysis
will always be quickly stolen from their context and their
terminology, made mentalistic, psychodynamic, or quasineuro-
Effective but Underused
logical, and used widely by practitioners who credit their effec-
Thousands of studies show that people’s lives can be tiveness to cognition, inner motivation, or neurology. I predict
improved—can be more interesting, more independent, more that effectiveness will always be less in their hands than it
cooperative, and inclusive—by drawing on basic behavioral would be in the hands of proof-dependent functional analysts,
124 Research on Social Work Practice 23(2)

but because the techniques were developed in functionally Obstacles

analytic, proof-dependent hands, they will maintain some
effectiveness even in clumsy, nonanalytic hands. (Baer quoted We can use our contingency analysis skills as well as research
in Wesolowski, 2002, p. 144) in a variety of other areas to understand the neglect of ABA and
to identify obstacles and plan how to address them. The obsta-
cles suggested are interrelated.
We have a powerful technology compatible with research
findings concerning human behavior, yet one that is persis-
tently ignored in many venues where its application could
help people to enhance the quality of their lives. Thyer The Allure of Mentalism (Mentalistic Explanations)
(2005) noted that behavioral social work is misprized, mis- Mentalism can be defined as ‘‘an orientation to the study of
read, and misconstrued. Most texts in social work do not behavior, which holds that a unique, a necessary, and the pri-
include terms such as ‘‘behavior analysis’’ or ‘‘applied beha- mary contribution to the causal explanation of behavior con-
vior analysis’’ (let alone radical behaviorism). In most books sists in proposing various internal acts, states, mechanisms or
on theory in social work, there is no mention of radical processes, presumed to be operating in neural, conceptual, or
behaviorism or ABA. In Social Work Treatment: Interlocking psychic dimensions’’ (Moore, 1990, p. 20). Mentalistic expla-
Theoretical Approaches (Turner, 2011), behavioral theory is nations ‘‘appeal to the initiating causal efficacy of feelings,
included as one of 38 entries, all given equal space despite mental states, attitudes, thoughts, ideas, drives, needs, mem-
unequal evidentiary status. It is almost as if related words are ories, images, representations, sensations, reasons, purposes,
taboo or are a stigmata. beliefs, wants, desires, attributions, the ego/superego/id,
When not ignored, ABA and radical behaviorism are often moods, brain states, expectations, etc’’ (p. 20). Radical beha-
misrepresented (Thyer, 2005; Todd & Morris, 1983). Just viorism was termed radical because it is a sharp break with
recently at a conference on Science and Society at USC held methodological behaviorism. Private events such as feelings
in May 2011, one of the speakers said: ‘‘Some like behaviorists, and thoughts are viewed as behaviors that themselves need
do not acknowledge the importance or ‘reality’ of an internal explanation. This seemingly simple statement is profound in its
mental life’’ (Longhofer & Floersch, 2011). This incorrect implications. This means that we cannot use feelings and
statement could have been avoided by reading any number of thoughts as explanations for behavior as occurs in mentalistic
readily available original sources (e.g., Skinner, 1974). And, accounts; we must examine environmental contingencies.
there is ‘‘pilfering,’’ which may be good (help clients) or bad Those who favor mentalism appeal to cognitive processes such
(deprive them of greater gains by more systematic use of beha- as thoughts to explain behavior. There is a focus on interiors.
vioral theory and related technology). As Don Baer suggested, Appeal to interiors (thoughts, feelings, and brains) draws
‘‘powerful techniques of applied behavior analysis will always attention away from environmental contingencies that contrib-
be quickly stolen from their context and terminology’’ (Baer, ute to social and personal problems. If we examine what most
quoted in Wesolowski, 2002, p. 144). An example in social cognitive–behavioral therapists do, I suspect that we would
work is the renaming of scores of behavioral techniques as find that two thirds of their endeavors focus on interior events
‘‘task-centered practice,’’ hiding their origins (Gambrill, and their modification (such as changing what clients say to
1994). Approaches such as motivational interviewing (Christo- themselves). (This could be checked by an empirical investiga-
pher & Dougher, 2009) incorporate behavioral strategies as do tion of what is focused on in published studies as well as by col-
successful parent training programs which cite social learning lecting new data describing the focus of intervention.) Factors
theory as their guide (Triple P Parenting Program and Incred- that encourage mentalism include the vividness of thoughts and
ible Years Program; e.g., see de Graaff, Speetiens, Smit, de feelings, the ideology of success via ‘‘mind power,’’ and frag-
Wolff, & Taveccio, 2008). Non-take-up of effective interven- mented accounts in the media which ignore environmental
tions is of concern in all professions and is a common problem causes (Gambrill, 1992). We are often aware of our thoughts
(Straus, Tetroe, & Graham, 2009) encouraging the creation of and thus they are readily available to view as the cause of beha-
the process and philosophy of evidence-based practice and pol- viors and events that befall us in our lives. The same can be said
icy (Gambrill, 2006). of our feelings. These too are readily available. (See also later
Why is behavioral analysis and related theory often ignored discussion of cognitive biases.) This availability, combined
or misrepresented? Is not taking advantage of effective inter- with the tendency to think that we have discovered the cause
ventions a kind of mistake? Is it an oversight? Is it hampered (and thus the remedy) regarding behaviors or consequences
by interfering beliefs, problem-solving styles, and competing of interest, lull us into thinking we have discovered how to
contingencies? What can we do to increase the use of proce- change things for the better. There is an illusion of understand-
dures that have been shown to enhance quality of life? Profes- ing. If this is not true, they are false prophets (a kind of false
sional codes of ethics obligate us to become more effective positive) which get in the way of further inquiry.
marketers of interventions that enhance quality of life. Relying A focus on interiors encourages a disinterest in the behavior
on what feels right or what we believe, unaccompanied by a of clients and related environmental circumstances. An indica-
well-reasoned argument and/or by evidence, is incompatible tor of a disinterest in individual circumstances and characteris-
with obligations described in ethical codes. tics is illustrated by use of brief (one paragraph or one page)
Gambrill 125

vague summaries describing a client assumed to offer enough emphasized. Illouz suggests that the language of therapy has
information to understand a client’s life (e.g., warranting deci- been responsible for a cognitive and cultural process of ‘‘verbal
sions about what is wrong and what should be done). Lack of overshadowing’’ that makes self-introspection a substitute for
understanding of unique individual situations encourages a lack nonverbal ways of acting in social exchanges. Does this focus
of empathy for clients. Where is the empathy for a child when on interiors have a beneficial outcome? Her answer is ‘‘No.’’
we simply give him a label and prescribe medication, as occurs She contends that questions about ‘‘Why do the innocent suffer
for so many school children? Children in foster care are espe- and the wicked prosper? . . . that [have] haunted world religions
cially likely to be medicated (Carey, 2011; Government and modern social utopias, [have] been reduced to an unprece-
Accountability Office, 2011). Professional codes of ethics call dented banality by a discourse that views suffering as the effect
for use of the least restrictive interventions; medication is usu- of mismanaged emotions or a dysfunctional psyche or even as
ally not the least restrictive. Sperber (1990) argues that opinion an inevitable stage in one’s emotional development’’ (p. 246).
leaders as well as the rank and file members of the scientific
community are under relentless pressure to adhere to the latest
styles or trends considered to be in ‘‘good taste . . . ’’ (p. xi).
Seduction by Theory
Bauer (2012) argues that research cartels censor well-argued Some professionals focus on interpreting and explaining beha-
alternative views and promising directions of inquiry. vior. They may say they understand an event if an explanation
‘‘makes sense to them.’’ Different goals (interpretation and
Related popular grand narratives and metaphors. It is widely explanation or understanding based on successful prediction
believed that ‘‘mental illness’’ is the cause of troubled, trou- and influence) reflect different views of understanding and
bling, and very dependent behaviors. Indeed, to question this explanation. The professional literature in the interpersonal
belief is often viewed as heretical and deluded. The biomedical helping professions is replete with books and articles describ-
industrial complex has had phenomenal success in framing ing different theories regarding behavior, with little attention
problems as internally caused with the aid of its best friend, the to practical utility in helping people to enhance the quality of
Diagnostic and Statistical Manual of Mental Disorders (DSM; their lives. Qualifying examinations in social work in the
American Psychiatric Association, 2000), soon to appear in its School of Social Welfare at UC Berkeley examine students
fifth edition (Gambrill, 2012a). Biomedical explanations are on their knowledge of a range of theories with seeming little
used to account for an ever-increasing range of behaviors, interest in their practical utility. Indeed, in a recent doctoral
thoughts, feelings, and bodily conditions. (Mis) behaviors, qualifying examination bibliography on theories of the family
troubled or troubling feelings and thoughts are translated into approved by a faculty member, there was no mention of social
illness such as bipolar disorder, schizophrenia, ADHD, and learning theory, arguably, the most widely drawn on to design
hundreds of others including gambling and female sexual dys- effective assessment and intervention programs. Nettler (1970)
function (Moynihan & Mintzes, 2010). This category error, suggests that illusions of explanations are accepted when it is
assuming that behavior—what people do—equals illnesses, is more reinforcing to select empathic (based on feelings) or ideo-
widely ignored by players in the mental health industry and logical (based on beliefs) accounts.
their audiences. The number of listings in the Diagnostic and
Statistical Manual of the American Psychiatric Association
continues to increase. The slogan, ‘‘And more,’’ truly charac-
The Allure of Pathology
terizes this enterprise. The boundaries around categories of The DSM is one of the most successful (if not the most success-
alleged disorders such as anxiety in social situations continue ful) technologies in the history of mental health. It provides
to expand. The promotion of the belief that deviant or troubling about 5 million dollars a year to the American Psychiatric
behaviors are caused by an illness (a brain disease) has Association and is soon to appear in its fifth edition with even
spawned scores of industries and thousands of agencies, hun- more labels applied to even more behaviors. Such a technology
dreds of research centers, and thousands of advocacy groups fits with a disease model of deviant behavior and a focus
which forward this view. A disease model of alcohol abuse on ‘‘the self.’’ Related discourse makes creative use of look-
rules the day. Szasz (2001) argues that we live in a therapeutic alikes for science (pseudoscience and scientism; e.g., Boyle,
state (a pharmacracy) characterized by psychiatric control of 2002) and encourages a disregard of individual differences in
misbehavior by prescribed or coerced medication. opportunities and challenges. It has become accepted (and
The therapeutic grand narrative of clinical psychology more reinforcing) to ferret out interesting psychopathologies
focuses on the self as the prime site for management of life’s related to complaints than to discover environmental contin-
travails. Illouz (2008) argues that an ideal of social communi- gencies that affect what people do, think, and feel and contrib-
cation was created, incorporating the view that we gain self- ute to positive change. Central in applications of behavioral
knowledge by introspection which can provide guidance in analysis to clinical and social problems is the view that ‘‘beha-
understanding, controlling, and dealing with both our social vior always makes sense.’’ But this sense may only be revealed
and our emotional environment. Verbal disclosure was viewed via an understanding of related contingencies. This view is
as central in social relations. Self-observation, self-knowledge, quite the opposite of the grand narratives of clinical
and the responsibility to work on and alter our relationships are psychology and biomedical psychiatry which emphasize
126 Research on Social Work Practice 23(2)

deficiencies—their identification and causes, usually in the is variable and cannot be controlled or influenced in a systema-
individual, spurred on by Big Pharma, piggy backing on the tic way. It is believed that behavior is essentially unknowable.
ever expanding DSM. Third-party payment requires use of Knowledge about behavior is indeed incomplete. This may
these diagnostic categories. Research grants must use such breed a dissatisfaction and impatience with the slow pace at
classifications. The field of psychopathology is enormous which a science of behavior develops or result in a belief that
with subfields in child, adult psychology, and geriatric a science of behavior is not possible. The incompleteness of
psychopathology. The prefix ‘‘psych’’ emphasizes the knowledge often encourages theorizing about why technology
psychological—the individual—what lies within; the term is incomplete rather than continued experimental efforts to cre-
pathology focus on what is wrong. We hear these words ate additional knowledge (Baer, 1991).
endlessly which influences how we frame problems and
attempt to solve them.
Countervailing Contingencies and a Reluctance to Reveal
Them
Misunderstandings of Science
Sociologists and cultural observers such as Foucault (1973),
ABA is a scientific approach to understanding and altering beha- Illouz (2008), and Szasz (2001) bring to our attention the influ-
vior. Behaviorism is ‘‘a philosophy of science concerned with ence of the state and related institutions such as welfare pro-
the subject matter and methods of psychology’’ (Skinner, grams and prisons on what problems receive attention (and
1988, p. 278). Many objections to ABA are related to misunder- which ones do not) and remedies proposed. Health insurance
standings of science. Philosophy of science is a neglected area in companies are interested in saving money as reflected in a
most professional schools. Science is a way of thinking about reluctance to pay for interventions shown to be effective for
and investigating the accuracy of assumptions about the world. children with developmental disabilities. Managed care poli-
It is a process for solving problems in which we learn from our cies may not support effective interventions nor may policies
mistakes. Science rejects a reliance on authority (e.g., pro- and practices in schools and other kinds of institutions (child
nouncements by officials or professors) as a route to knowledge. welfare departments). The helping professions are big business
Authority and science are clashing views of how knowledge can (see Stid, 2012). Consider the multibillion dollar pharmaceuti-
be gained. Surveys show that most people do not understand sci- cal industry. Consider the huge assessment industry. Hundreds
ence (National Science Foundation, 2006). Misunderstandings of schools graduate thousands of social workers, counselors,
about science may result in ignoring this problem-solving and psychologists each year. Most professionals are unin-
method and the knowledge it has generated to help clients formed regarding ABA and related research, theory, and philo-
enhance the quality of their lives. Textbooks often omit contro- sophy and its application to the pursuit of outcomes clients
versy giving an illusion of a logical progression of uncomplex value. Thousands of social workers graduate each year from
discovery, when indeed, the process is quite different, involving bachelor’s, master’s, and doctoral degree programs with a pris-
chance discoveries, conjecture, and controversies. Journal arti- tine ignorance of ABA and related theory. All these enterprises
cles often omit controversy about causes and evidence. Science exist because of maintaining contingencies. Many interested
is often misrepresented as a collection of facts or as referring parties go out of their way and devote considerable resources
only to controlled experimental studies. Many people confuse to hide context (what is done to what effect). Consider exposure
science with pseudoscience and scientism. of conflicts of interest including those of academic researchers
Scientific thinking rejects a search for final answers. It is (Lo & Field, 2009). Behaviorism is radical in closely examin-
hard to give up illusions of control that are questioned by ask- ing context and related contingencies, taking advantage of
ing for evidence. Scientific thinking may thus interfere with observation when possible. Who is reinforcing whom for what
one of the functions of lay beliefs—making the world a stable, behaviors with what consequences? Description of involved
orderly, and predictable place (Furnham, 1988). Thinking criti- contingencies, some of which may facilitate and others of
cally about the causes of a problem such as poverty or sub- which may hinder change (exert counter control), are important
stance abuse may call into question comfortable positions. If to identify in order to select valuable entry points and behaviors
you can no longer blame the people who have the problems, and contingencies to alter. Are there entry points such as con-
maybe something should be done to alter environmental cir- sumer groups which may encourage a positive cascade effect?
cumstances related to these problems. Far from reinforcing How can we avoid entry points which encourage the opposite,
myths about reality, science is likely to question them. All sorts negative cascade effects which result in development of even
of questions that people may not want raised may be raised, greater countercontrol?
such as: ‘‘Does this residential center really help residents?
Would another method be more effective? Does what I’m
doing really help clients? How accurate is my belief
The Plethora of Propaganda in the Helping Profession
about ——?’’ Misunderstanding about science may result in Propaganda refers to encouraging actions, adherence, and par-
ignoring this problem-solving process. Some people believe ticipation with as little thought as possible (Ellul, 1965, p. 180).
that the scientific method is inappropriate to apply to human Propaganda can be contrasted to critical thinking—arriving at
behavior. Reasons given include the assumption that behavior well-reasoned beliefs and actions (Gambrill, 2012b). Common
Gambrill 127

methods include censorship, distortion, confusion, and even and censorship of well-argued competing views. These skills
fabrication. As Rank (1982, 1984) suggests, we highlight the may be polished in graduate school. Both advertisements and
positives of our view, hide the negatives, and highlight the content in the professional literature distort reality by selective
negatives of competing views and hide the positives. Consider presentation of data to forward a certain view and related product
distortions and misrepresentations of behavioral methods (e.g., and use similar techniques to do so. Similar goals and strategies
Thyer, 2005) and of evidence-based practice (Gambrill, 2011). are evident in both (Gambrill, 2012a). Both create an illusion of
ABA involves a constructional approach to change in which knowledge and achievement of valued goals. We see our usual
there is a focus on constructing repertoires including those propaganda ploys—bold assertions including inflated claims
which compete successfully with undesired behaviors (Goldia- about ‘‘what we know,’’ and ‘‘what works’’ or what is done, hid-
mond, 1974, 1984; Schwartz & Goldiamond, 1975). Descrip- ing context such as well-argued alternative views, distorting
tions of ‘‘strength perspectives’’ in social work typically facts and figures, and appeals to authority such as uncritical doc-
ignore related literature and falsely claim that their model is umentation (attaching citations to a claim without any descrip-
unique in focusing on client assets. Related books also illustrate tion of what these citations contain). There seems to be a
the ‘‘picking off’’ of behavioral strategies unrelated to their the- negative correlation between the status of a profession and the
oretical underpinning. tendency to publish advertisements disguised as research articles
Ellul (1965) argues that propaganda is integral to the techno- (marticles). That is, the lower the status, the more marticles
logical society in which we live. (See also Ellul, 1964.) Propa- appear, as in social work and psychiatry compared to medicine.
ganda offers an escape from the alienating effects of such a Altheide and Johnson (1980) argue that the greatest source of
society, such as anxiety and loneliness. We have a ready ideol- propaganda today is bureaucratic—endless agency reports
ogy that offers a reason for our miseries and an excuse for our designed to gain or continue funding which reveal little detail
actions. Our psychological vulnerabilities, for example, to ‘‘be regarding what is done to what effect. The old adage ‘‘Buyer
right,’’ to be ‘‘one of the in-crowd,’’ contribute to the success of beware’’ can be generalized to be critical of what you read, even
propaganda. Propagandists influence our choices by how they in professional texts and journals.
frame decisions (e.g., as losses or gains, delayed, or immedi-
ate). Revelations of conflicts of interest over the past years and
related propaganda (fielding of dubious diagnoses such as
Gullibility
‘‘pediatric bipolar disorder’’ and promoting neuroleptic medi- We are gullible creatures as any history of science, ideas, fash-
cation for toddlers has resulted in a vigorous backlash (e.g., ion, or just about anything else would testify (e.g., see Cialdini,
Angell, 2009; Lo & Field, 2009). Self-propaganda is intimately 2009; Thyer & Pignotti, 2010, 2011). We are easily deceived,
related to propaganda from other sources; the two become duped, or cheated. Some hoaxes are so successful they have
closely intertwined, encouraged by years of prepropaganda in been practiced for centuries. Many persuasive appeals play
our schools (Ellul, 1965). Consider the progression of students on our emotions as in appeals to special interests or disliked
through their education. By the time they arrive in professional groups. The ad-like character of much material in the profes-
degree programs, they may have had little experience and men- sional literature (articles, chapters, and texts) in tandem with
toring in close observation of environmental influences and a common biases to which we are subject such as overconfidence
great deal of practice using mentalistic descriptions. and confirmation biases, increase the likelihood that we will be
Hiding well-argued alternative views may result in misdirec- bamboozled. For example, our belief in a view may result in
tions and oversimplifications that mislead rather than inform us missing or dismissing methodological limitations in studies
about what is a problem, what kind it may be, what causes it, and favorable to this view, especially when they are minimized
what can be done (if anything) about it. Consider ignoring or ignored by authors. This contributes to an illusion of
research concerning the role of therapist alliance and allegiance learning—an illusion of knowledge acquisition and dissemina-
in contributing to positive outcome in publications overpromot- tion. We may not know that articles we read were written by
ing ‘‘evidence-based’’ practices. (For discussion of the role of ghostwriters hired by pharmaceutical companies but published
such factors see Duncan, Miller, Wampold & Hubble, 2010; under the name of a well-known academic. Gullibility has
Norcross & Lambert, 2011; Wampold, 2007.) We see inflated many advantages. Time is saved, sure answers are claimed, and
claims of accuracy and evidentiary status regarding favored one can belong to a subgroup of fellow believers.
views and hiding and/or distorting of well-argued alternative
views and related evidence (e.g., see Gorman & Huber, 2009).
This kind of deception goes hand in hand with seductive appeals
Misleading Use of Language
to our self-interests in being healthy, popular, right-living, Language may mislead us because of carelessness, lack of skill
achieving the good life, and avoiding the bad. Ignorance of ABA in writing and thinking, or deliberate intent to mislead on the part
enables related propaganda to be effective; propaganda of a speaker or writer. Unless we are skilled in avoiding the
flourishes where ignorance reigns. Propagandists are skilled in misleading influence of words, our lives may be shaped by the
use of strategies such as distracting our attention from the lack words we use, see, and hear in ways that harm rather than help.
of evidence for claims by name dropping (e.g., ‘‘as Freud said’’), Applied behavior analysts have devoted considerable attention
bogus citations (they contain no support for the related claim), to equivalence relations and their effects (e.g., Dymond, Roche,
128 Research on Social Work Practice 23(2)

Forsyth, Whelan, & Rhoden, 2007; Sundberg &Michael, 2001). unaware of or do not like. Failure to recognize environmental
Just as thought may corrupt language, language may corrupt influences is a key reason distortions and misrepresentations
thought (Orwell, 1946/1958). ‘‘Weasel worlds’’ provide an illu- of ABA and radical behaviorism are so readily accepted. As
sion of argument or clarity. Examples include Skinner (1971) suggests, ‘‘casual observation alone will sel-
dom reveal the contingencies’’ (p. 148). Patterns of reinforce-
 ‘‘Many people say . . . ’’ How many? Who says so? On what ment that affect behavior are not obvious. If environmental
basis? influences were more vivid, their role would be more difficult
 ‘‘Some people argue that . . . ’’ Who? On what basis? to deny and disregard, including contingencies related to beha-
 ‘‘Studies show . . . ’’ What studies? How sound are they? viors that could successfully compete with those complained
 ‘‘Experts suggest . . . ’’ What experts? On what basis? of. What conditions contribute to ignoring environmental vari-
 ‘‘It is notable that . . . ’’ On what basis is it notable? ables? Why did people not ‘‘see’’ the ape crossing the stage
 ‘‘Obviously . . . ’’ How is it obvious? What is the evidence? (see Ariely, 2009). We can draw on theory and research con-
cerning decision making and related cognitive biases and illu-
Weasel terms such as ‘‘it is well known that . . . ’’ ‘‘It is widely
sions to help us understand why environmental variables tend
accepted that . . . ’’ (when indeed there is controversy) are used
to be ignored (Gambrill, 2012b; Pohl, 2004). Examples of cog-
in lieu of arguments. We may believe that because a word
nitive biases include confirmatory biases in which we seek only
exists, what is referred to exists (reification). The terms science
information compatible with our preferred views and wishful
and scientific are often used for persuasive rather than descrip-
thinking (e.g., Taber & Lodge, 2006). We often mistake corre-
tive purposes. That is, the term scientific is often used as an
lation for causation and causes and their effects. We underesti-
adjective to enhance the credibility of a view or approach even
mate the role of chance and are subject to the fundamental
though no scientific evidence is available that supports the
attribution error (attending to personality characteristics of
view. The term science has been applied to many activities that
individuals and overlooking environmental variables). We tend
in reality have nothing to do with science. (See also critiques of
to ignore base rate information and are subject to hindsight
‘‘evidence-based practice,’’ Gorman & Huber, 2009).
bias. Either-or thinking may lead us astray—considering only
Combs and Nimmo (1993) describe palaver as a kind of dis-
two alternatives when there are more. We are subject to the
course in which truth and falsity are irrelevant. It includes ram-
‘‘validity effect.’’ This occurs when the mere repetition of
bling speech and digressive claims presented in appealing
information affects the perceived truthfulness of that informa-
ways. Obscure writing often appears more profound than clear
tion (Renner, 2004).
writing. Armstrong (1980) found that material presented in
In everyday life, we often attribute behavior to feelings and
obscure wording was deemed more profound and scientific.
thoughts. A counselor may write in her record, ‘‘Mrs. Jones
In palaver, truth is irrelevant. There is no concern for truth, only
tried to kill herself because she felt lonely and believed no one
to create credibility and for guile and charm. As Frankfurt
cared about her.’’ But, why did she feel lonely? Why did she
(1986) suggests, ‘‘he does not reject the authority of truth, as
believe no one cared about her? Such accounts stop too soon.
the liar does, and oppose himself to it. He pays no attention
They are incomplete. What is going on in her life that may
to it at all’’ (cited in Combs & Nimmo, 1993, p. 340). Frankfurt
be related to feelings, related thoughts, and the suicide attempt?
suggests that faking is inevitable whenever circumstances
Feelings and thoughts are vivid, thus readily available to
require that we speak without knowing what we are talking
assume as causes of behavior. Propagandists take advantage
about. In advertising and in professional publications, palaver
of this vividness to encourage confusion between feeling free
is used to make small or no difference between products look
and being free. They may pronounce: ‘‘You are free to
substantial to encourage us to purchase one product rather than
choose,’’ when, because key information is hidden and alterna-
another. This is also the case with alleged differences among
tives offered have been shaped by others, you are not free. As
the hundreds of psychotherapies available. We are complicit
Skinner (1971) suggests, just because you feel free does not
in perpetrating this reign of palaver in our failure to be skepti-
mean you are uninfluenced by your environments. Environ-
cal. Problems are viewed as solvable via discourse—expres-
mental circumstances are less vivid, and so easily overlooked,
sions of concern and description of efforts. The problem
especially by professionals who rely on clients’ self-report in
actually remains but is ‘‘solved’’ for the politician because pro-
interviews (the office-bound professional). So too is our past
paganda produces the desired effect on the public (Combs &
history (biographies that shape our behavior) typically less
Nimmo, 1993, p. 236). Thus, problems are viewed as ‘‘a prob-
vivid unless focused on, as in certain kinds of therapy. The
lem of propaganda.’’ Propaganda is the solution to political or
reinforcement history of complained of behaviors (or their
other organizational problems because it creates a semblance
lack) is hidden in the past. We see only its reflections in the
of reality.
present. Consider a child diagnosed with ADHD. Related beha-
viors such as shouting, hitting, and leaving the room are vivid.
The related reinforcement history is hidden. Hidden in the past
The Prevalence of Cognitive Biases are thousands of reinforcement occasions for troubling or
Trying to solve problems is influenced by what we observe and troubled behaviors and perhaps even more lost opportunities
what we do not; what theories we prefer and which ones we are to reinforce desired alternatives. Our tendency to be influenced
Gambrill 129

by vivid events such as feelings draws attention away from the The push for efficiency and standardization creates an erasure
environment. If we are not trained to think about ‘‘reinforce- of individual differences (Illouz, 2008). Both children in foster
ment history’’ but have taken courses focused on theories of care and the elderly are too often placed on medication rather
development, mentalistic concepts such as low self-esteem than understanding and altering contingencies related to their
may leap to mind as causes of complained behavior with their behavior (e.g., Government Accountability Office, 2011; Levin-
implication of a focus on interiors (raising self-esteem). son, 2011). Parent training programs that clients receive in child
Alternative repertoires related to vivid complained-of beha- welfare services are not those most likely to be effective (e.g.,
viors such as phobias, compulsions, hallucinations, temper tan- see Barth et al., 2005). Assessment is minimal; everyone may
trums, and bullying are not obvious without the conceptual receive the same program. Consider the example of a child wel-
orientation to seek them and the technical skills to discover fare worker called out to a home in which there was concern
them (e.g., by having clients complete daily logs regarding about abusive parenting practices. Upon arrival of the social
what they do and related circumstances; Schwartz & Goldia- worker at the home, the father said, ‘‘No, wait’’ and rushed into
mond, 1975). Nor are maintaining contingencies of disliked another room and brought out four certificates that he had
behaviors obvious; the form of behaviors such as tantrums cap- received from attending four different parenting programs. This
tures our attention. The form of a behavior may not reveal its example illustrates the ritualistic nature of a great deal of inter-
function. Without recognizing this vital distinction, we may vention and the related enormous waste of money. Also, given
assume that alternative repertoires which may compete suc- that such interventions are ineffective or harmful, they may cre-
cessfully with an undesired behavior must look similar when ate an illusion of knowledge (a parent may think they know more
indeed, totally different forms of behavior may be maintained when they do not) or (even worse) contribute to a believe that
by the same reinforcer. What doctor would jump to a conclu- one is ineducable. With the money saved from not offering inef-
sion that a fever indicated a certain cause, that a rash was due fective or harmful programs, we can train staff to offer effective
to a certain cause, or that shortness of breath was caused by a programs. In contrast, ABA is deeply concerned with individual
particular circumstance? Yet in the interpersonal helping pro- differences in learning histories and current contingencies and
fessions, we see such ‘‘jumping to conclusions’’ everyday. related implications for selection of interventions. ABA requires
Consider the acceptance of ‘‘past trauma’’ as the cause of a attention to real-life worlds in which a client lives. But this takes
wide variety of problems. time. It takes skill in observation. Who will pay? Who will suffer
if payment is not forthcoming?

Lack of Critical Thinking Skills and Related Dispositions

Problems may be created or remain unsolved because we rely Codes of Ethics Without Creating Related Controlling
on questionable criteria to evaluate claims about what is accu- Conditions Offer an Illusion of Ethical Practices and
rate, such as tradition, popularity, or authority (Gambrill, Policies
2012b). Thinking critically about claims is not valued by many
Every profession has a code of ethics describing obligations of
groups and individuals. To the contrary, individuals and/or
practitioners. These codes call on those in a profession to help
groups may try to hide the effects of practices and policies
clients and avoid harming them and to involve them as
by relying on propaganda methods and appealing to pseu-
informed participants. Given harming in the name of helping
doscience as suggested earlier. Phillips (2000) argues that rais-
and the fact that most clients are not involved in helping efforts
ing questions about ‘‘truth’’ has the taboo quality today that
as informed participants, clearly these codes alone are not
talking about sex had in Victorian times. Both critical thinking
effective in influencing behavior. Indeed, it could be argued
and evidence-informed practice and policy encourage asking
that they do more harm than good because their existence, in
questions designed to make the invisible visible, including
the absence of the necessary controlling conditions to ensure
uncertainties and inequities related to decisions (e.g., see Data-
they are honored, conveys an illusion that practitioners are
base of Uncertainties About the Effects of Treatments
doing the right thing, just as a bogus certification on a food
(DUETS) at http://www.library.nhs.uk/duets/).
product may give an illusion of safety and/or nutritional value.
Consider informed consent obligations. What controlling vari-
ables would have to be arranged to increase the probability that
The Press for Efficiency and Standardization clients are not misinformed or uninformed, but involved as
Ellul (1965) argues that ‘‘modern man is obsessed with tech- informed participants? What conditions would have to be
nology’’ (p. 59). Technology strives for ever greater standardi- established to ensure that practitioners accurately describe their
zation and efficiency. Pains and symptoms must be classified competence to clients/patients? Should we use a form similar to
so forms can be easily completed and resultant classifications one suggested by Entwistle and her colleagues which requires
given Latin names so they give the illusion of objectivity. Do professionals to clearly describe to clients the evidentiary status
standardized measures accurately reflect quality of life (e.g., of services offered compared to alternative methods as well as
Carlon et al., 2010; Mularksi et al., 2007)? Does observation the track record of success of those who will offer them
in real-life settings provide a corrective guide? (Entwistle, Sheldon, Sowden, & Watt, 1998)?
130 Research on Social Work Practice 23(2)

Exactly what behaviors in what circumstances are required book (Roelen & Gassman, 2012). Measures of child well-
regarding each ethical obligation? What circumstances require being include many of these in addition to indicators such
deviations (alternative behaviors)? What is the range of beha- as proportion of children who report being beaten or insulted
viors (the operant) that results in a specific related hoped-for as part of punishment/discipline and percentage of children
outcome? To what degree do those behaviors identified as who report having a good or very good relationship with a
‘‘ethical’’ facilitate positive outcomes for clients and signifi- peer (Hoelscher, Richardson, & Bradshaw, 2012, see also
cant others? To what extent does a client’s view of positive out- Maholmes & King, 2012). We should make the avoidable suf-
come overlap with the views of significant others? fering that results from not taking advantage of a science of
behavior more visible. How many people spend their days
in punishing environments with few pleasurable conse-
A Path Ahead quences (e.g., those with nothing to do)? Although many more
We can do more to encourage greater use of a science of beha- children come into care because of neglect, most research
vior and related theory to help people to enhance the quality of attention is focused on abuse. Neglect is not as vivid because
their lives. And, as suggested earlier, we are ethically obligated we do not make it so. Do we count the hours when a child is
to do more. What should this ‘‘more’’ consist of to maximize emotionally and cognitively neglected? In ‘‘Meaningful dif-
success in decreasing gaps between what is likely to help cli- ferences,’’ Hart and Risley (1995) gathered data regarding the
ents attain valued outcomes and what is done? How can we verbal environment in 3 distinct SES (socioeconomic status)
encourage clients to advocate for and professionals to take categories: professional working, and welfare. Sizable differ-
advantage of methods that improve quality of life for clients ences were found in the frequency of words spoken by parents
and significant others (e.g., see Risley, 1996)? How can we to their children. ABA is in part a science of minimizing
make theory and technology that helps clients more interesting, avoidable suffering.
indeed of vital appeal? If ABA and quality of life are birds of a Exposing avoidable suffering on a steady basis in multiple
feather, we must raise our appeal to many different audiences. areas would hopefully potentiate concerns about these negative
A great deal of this ‘‘more’’ consists of revealing avoidable consequences and generate effective countercontrol to change
ignorance as suggested in the sections that follow. We should circumstances. This is especially needed in settings in which
help both professionals and clients to see what is not obvious options for countercontrol on the part of those experiencing
(what is hidden) such as conflicts of interest that maintain inef- adverse effects are limited. As Skinner (1971) notes, ‘‘those
fective (or harmful) service programs and consequent avoid- who are concerned for the welfare of people in mental hospitals
able suffering and waste of money (e.g., see Tanne, 2012). and many other institutional settings, including prisons often do
Ignoring individual differences in unique alternative available not know what is happening in such settings because control
repertoires (AARs) and life circumstances and histories and countercontrol tend to become dislocated when control is
decreases the likelihood of understanding clients, including taken over by organized agencies’’ (p. 171). Ignorance is the
their individual subjectivities. This calls for revealing avoid- controllers’ and the propagandists’ friend. Appeal to feelings,
able ignorance. Proctor and Schleibenger (2008) suggest that states of mind, and mental illnesses allow the former to mystify
the study of ignorance is as important as the study of knowl- sources of avoidable suffering (place causes in the individual).
edge. All professional schools should introduce students to the Such appeals obscure alternative accounts that may reveal
tapestry of ignorance that influences their work with clients and needed changes in environmental contingencies. As Skinner
related consequences. We can help people think like Sherlock (1971) suggests, ‘‘Young people drop out of school, refuse to
Holmes who noticed the importance of the fact that the dog did get jobs, and associate only with others of their own age not
not bark. We can help parents to see that the quietness of a child because they feel alienated but because of defective social
should be an occasion for a loving hand or fun game rather than environments in homes, schools, factories, and elsewhere’’
for continuing to Twitter or text. We can help an inattentive (p. 15). We have let clients and their significant others as well
spouse to notice the yearning of his or her partner for attention, as professionals down, by not making greater efforts to make
so removing the need to seek attention via fears and obsessions. visible lost opportunities to help clients minimize avoidable
suffering.
What percentage of fourth graders referred to a social
Reveal Avoidable Suffering Due to Gaps Between What
worker for out-of-control behavior in the classroom are recipi-
Could Be and What Is Done ents of a functional assessment (see Cipani, 2012) and what
Revealing avoidable suffering is a key way to gain media atten- percentage receive intervention based on this assessment
tion and interest of involved decision makers, to recruit con- including at least a 6-month follow-up to maintain gains? What
sumer support and to recognize ‘‘crises’’ (opportunities for a percentage are helped by this approach at what cost? What per-
positive cascade effect). Indicators of poverty, stress, and centage of children receive other kinds of services and what
deprivation are becoming more specific. Examples include per- percentage are helped by these? What percentage are not and
centage of children not enrolled at appropriate educational lev- at what costs (e.g., social, emotional). This kind of data would
els, living in dwellings with no electricity, absence of safe allow us to identify and expose gaps between what is and what
drinking water, not having toys, and not having at least one should be as well as their consequences such as avoidable
Gambrill 131

suffering and loss. In exposing these gaps, we should try to cap- Table 1. Avoidable Suffering: Children With Developmental Disabil-
ture multiple kinds of costs and benefits, both current and ities in Oakland California.
future, including emotional, economic, and social costs of one 1. Description of specific problem/need.
intervention compared to another, both now and in the future. 2. Estimated prevalence of each.
Let us say that a behavioral approach based on findings from 3. Are there effective interventions for each: ___yes ___ noa
the experimental analysis of behavior is more effective than 4. Percentage of children who obtain effective interventions in a
other methods to achieve certain outcomes. We could trace timely manner for each problem/need. ___%
possible consequences over just 1 month. How many lost 5. Cost–benefit analysis of consequences of gaps between
opportunities for reinforcement of positive behaviors result knowledge available and what is used regarding each problem/
need.
from each day in different programs? What is the rate per day? a. For individual children and their significant others (e.g., peers,
What is the rate for the child, the teacher, other members in the teachers, family members):
class, and the child’s parents? How many avoidable instances  Lost opportunities for positive reinforcement of different
of punishment resulted from different programs? What is the kinds (e.g., social approval, fun) and consequences.
overall positive to negative ratio in terms of consequences  Lost opportunities for acquisition of new repertoires and
maintaining behavior? What kind of ‘‘tipping’’ points occur related effects.
(e.g., reinforcement patterns/schedules that tip a person into a  Lost opportunities to avoid adverse consequences and
related effects.
depression or state of elation)? What kind of positive or nega- b. Benefits and costs to taxpayers both now and in the future.
tive cascades occur and under what kinds of circumstances? c. For professionals.
Psychological distress affects mortality and enjoyment of  Lost opportunities for profit from offering ineffective and/
everyday life (e.g., see Russ et al., 2012). or harmful programs.
In modern times, it seems that journalists are most likely to  Lost opportunities to gain satisfaction by reducing
blow the whistle on harmful interventions and their effects avoidable suffering.
including punitive, neglectful conditions in group homes for 6. Descriptive analysis of factors related to gaps.
 Avoidable suffering due to gaps.
those labeled ‘‘mentally ill,’’ those with developmental disabil-  Who gains what from current patterns of services?
ities, and those for the elderly, many of whom spend their last  Who would gain and lose what from decreasing gaps?
days in vapid nursing homes, overmedicated and undertouched 7. Ethical audit of consequences of gaps drawing on five and six
and uncared for (e.g., Levy, 2002). Popper (1994) suggests that based on obligations in professional codes of ethics.
we do not know how to make people happy but that many 8. Plan for sharing information with media and decision makers.
would agree on what is avoidable suffering. He proposed an 9. Plan for decreasing avoidable suffering.
agenda for public policy consisting of ‘‘ways and means of a
If not, does prevalence warrant a high priority for research.
avoiding suffering, so far as it is avoidable’’ (p. 124). For com-
plaints that reflect avoidable suffering we should do the
following are few opportunities, there will be little behavior, includ-
ing perhaps, even complaints.
1. Clearly describe it as well as common related contingen- 2. Determine its prevalence.
cies. Who is to say what avoidable suffering is? Adapta- 3. Determine if there is an effective intervention. Is there a
tion to low levels of positive reinforcement may result in recent Cochrane or Campbell systematic review addres-
a lack of complaints. People are remarkably adaptable sing the issue? A question here is who is to say what is
and creative in responding to changing levels and kinds effective? (See prior discussion of social validity.)
of reinforcement. This very adaptiveness may result in 4. Estimate the percentage of individuals who have the com-
the slow withering of verbal complaints and perhaps even plaint (or are complained about) who receive effective
signs of distress as scanty reinforcement schedules result intervention.
in a profound resignation reflected in silence and possible 5. Conduct a cost–benefit analysis regarding the conse-
quietness as in those sitting or laying in nursing homes. In quences of providing (or not) effective intervention in
the absence of verbal complaints which such histories relation to prevalence drawing on our values and technol-
may reflect, we must use our eyes to see avoidable mis- ogy related to social validity to capture the subjective as
eries. Here too, the behavioral literature suggests valid well as objective consequences in order to accurately por-
observational methods and possible interventions to tray seriousness and impact (e.g., avoidable suffering and
entice the demoralized (such as reinforcer sampling). Our lost opportunities for reinforcement; See Table 1).
adaptiveness is shown by those whose environments 6. Conduct a contingency analysis to determine factors
encourage behavior viewed as deviant (e.g., selling related to gaps discovered. Who benefits from current
drugs) as in poor neighborhoods with few opportunities patterns of reinforcement? Who loses? Who makes money
for valued employment (Wacquant, 2009). Would we too by providing ineffective services to clients/students?
come under the influence of such contingencies? Focus- 7. Conduct an ethical audit regarding what is found in five
ing on avoidable suffering highlights the importance of and six highlighting kinds, frequencies, and intensities of
attending to opportunities for reinforcement. Where there avoidable suffering and interrelationships among them.
132 Research on Social Work Practice 23(2)

8. Widely share this information with the media and deci- effective as professionals (e.g., social workers)? Or does
sion makers in varied venues including a user-friendly offering services via a trained professional contribute to
website (see later discussion). Transparency International the view that something useful has been done? Could we
ranks all countries in terms of prevalence of corruption use a computer program to attain hoped-for outcomes? For
(www.transparencyinternational.org). We could create a example, computerized cognitive behavior therapy is used
list of programs ranked in terms of prevention of avoid- in Scotland (NHS 24). Maybe all that is needed to perk up
able suffering. Exposure of avoidable suffering and other some of the dejected is to receive a text message at unpre-
harmful effects such as waste of scarce resources result- dictable times: ‘‘How r u?’’ But for how many?
ing from continuing to provide ineffective services and 2. Situations in which a great deal could be done, given a
the related deceit, greed, and indifference will encourage well-trained behavior analyst. What are these situations?
change. Indeed, the gross excesses of the biomedical As Haynes, Leisen, and Blaine (1997) suggest, ‘‘a func-
industrial complex in terms of fraud and conflicts of tional analysis is likely to be more cost-effective for some
interest have resulted in a vigorous backlash (e.g., see behavior problems than for others’’ (p. 346). How flexible
Pharmedout.org, healthyskepticism.org). can we be and attain similar outcomes? Greater attention
9. Identify and alter contingencies to increase effective has been given to system-wide changes needed to establish
services and decrease ineffective and harmful ones. and maintain behaviors that contribute to quality of life
A descriptive analysis will suggest entry points for (e.g., Freeman et al., 2001; Sailor et al., 2009). Still there
change. Change at many levels may be required, is a long way to go. For example; although coaching and
including professional education, institutional settings, feedback are vital for maintaining effective teacher beha-
and managed care companies. See, for example, Malott viors, in most schools these valuable interventions are not
and Glenn’s (2006) discussion of macro and meta- used (Keyworth, 2012).
contingencies. In doing so, we can draw on the research
findings from the experimental analysis of behavior, both
Create a Functional Typology Revealing the Complexity of
in the laboratory and in the clinic and other sites such as
schools and hospitals. Changes in dysfunctional
Environmental Circumstances Related to Concerns
education programs and accreditation methods may be Skinner (1974) suggested that ‘‘A science of behavior is espe-
required and/or alternatives developed (e.g., see Baker, cially vulnerable to the charge of simplification because it is
McFall, & Stroham, 2008; McFall, 2012; Stoetz, Karger, hard to believe that a fairly simple principle can have vast con-
& Carrilio, 2010). The exposure of avoidable suffering sequences in our lives’’ (p. 231). The writing of many behavior-
may be required to overcome countercontrol by those ists including Don Baer and B. F. Skinner is very clear. Key
involved (e.g., professors in social work education points can be all too quickly read and dismissed as irrelevant,
departments; principals in schools, administrators in such as the statement that feelings are clues to contingencies.
hospitals, prisons, and managed care companies). To dispel misrepresentations that ABA is ‘‘simple’’ or ‘‘simple
10. Report successes and failures and ‘‘try again’’ in an minded,’’ we must do a better job of revealing the complexity
iterative process over time. of application (e.g., Kanter, Cautilli, Busch, & Baruch, 2005;
Layng, 2009). The seductive allure of pathology and of ment-
If doing nothing about a problem is more aversive that doing alism may be countered by repeated illustrations of the varied
something even though the something does not change com- kinds of environmental contingencies that influence behavior
plained of behaviors, perhaps, as Baer and his colleagues including creation of very unusual repertoires (behaviors that
(1987) suggest, this is better than doing nothing because there appear bizarre) and the difficulty in identifying influential con-
is some social validity for some involved people. If doing some- tingencies (e.g., Goldiamond, 1974, 1984).
thing is better than doing nothing, then there are many people Appeal to thoughts and feelings are incomplete accounts
who can do that something such as thousands of social workers which, when viewed as complete, hinder change. Somehow,
who work in schools, hospitals, child welfare departments, and we must show this over and over by memorable accounts of lost
many other venues. If the doing something is accompanied by opportunities to help clients by accepting incomplete accounts.
a well-regarded explanation in the field such as attachment the- Only by a contextual analysis of problems is the heroic nature
ory, life span development, ecological theory, or trauma theory, of clients revealed. Behaviors that appear bizarre are usually
this may contribute to the view that something of value has been creative (but costly) solutions to life’s challenges (Goldia-
done and something of value has resulted. This indeed is what mond, 1974). Only in light of scant opportunities for positive
happens now. But different kinds of circumstances are involved reinforcement for adaptive behaviors may the occurrence of
in related complaints. Situations include the following troubling or troubled repertoires be understood. Examples
could be arranged under varying kinds of controlling condi-
1. Situations in which nothing could be done to change cir- tions including positive reinforcement, negative reinforcement,
cumstances related to avoidable suffering. But how would punishment, mixes of all three, scheduling effects, contrast
we know this without a contingency analysis by someone effects, influence by equivalence relations, potentiating effects,
who knows what they are doing? Would volunteers be as stimulus control, and so on (e.g., Baer, 1982, Waltz & Follette,
Gambrill 133

2009). We should describe memorable examples for each kind Examples should include those that require simple interven-
of circumstance to encourage understanding. Examples include tions that are effective (e.g., use of stimulus control—creation
of a ‘‘sulking stool’’ to decrease sulking behavior (Goldia-
1. adventitious reinforcement; mond, 1965) as well as those that require complex interven-
2. linking a positive reinforcer with an aversive event (e.g., tions (e.g., Goldiamond’s [1984] systemic analysis and
only if I get a shock will I get food—not starve). Only if intervention regarding a woman who engaged in ‘‘binge
I appear to have an immobilizing anxiety or obsession will eating’’). Examples will illustrate that behaviors that appear
I get attention from family members or famous therapists. irrational are shaped by environmental contingencies and are
3. Only if I perform a certain response within a set time will I maintained by current reinforcement patterns. No matter how
avoid a bad event (e.g., as in Sidman avoidance schedule). bizarre or dysfunctional a disturbing behavior may seem (the
4. variable ratio schedules and their effects (e.g., as in DB), when the history and current environmental context are
gambling). explored, including AABs, and the costs and benefits related
5. low levels of reinforcement for any behavior. to these different behaviors are compared, we can see that DBs
have been selected by the social environment (Layng & Andro-
For each, we should provide vivid case examples of topical, nis, 1984). For example, only by acting ‘‘crazy’’ may a person
linear, and systemic analyses. In a topical analysis, there is a gain access to resources provided only to those who act
direct focus on a disturbing behavior (DB), for example, hallu- ‘‘crazy.’’ This kind of analysis that attends to function (process)
cinations or talking out of turn in class. Topical analyses may rather than form (e.g., DSM, 2000), normalizes deviant beha-
be linear or nonlinear. In linear analyses (‘‘eliminative’’ or viors by making them understandable in relation to unusual
‘‘pathological’’ approaches), there is a direct focus on the DB environments; behavior always ‘‘makes sense.’’ The stronger
and eliminative methods are used such as extinction, punish- the belief in ‘‘mental illness’’ (brain disease as the cause of odd
ment, and/or response cost to decrease the DB (Andronis, behavior), the greater the resistance to this normalizing view
Layng, & Johnson, 1997). The effects on the DB of conse- may be. But the key question should be: ‘‘Which view is more
quences attached to available alternative repertoires (AABs) likely to enhance quality of life for clients and their significant
are ignored in a linear analysis (Goldiamond, 1984, p. 535). Let others?’’
us say the DB is yelling in class and the teacher makes the stu-
dent stay 10 min after class each time he yells out. She is using
Help All Involved Parties to Detect and Avoid Influence by
an eliminative method focused on the DB. Topical nonlinear
analyses also focus on the DB such as yelling out in class, but
Propaganda
a desired alternative such as raising his hand or waiting to be Getting the straight scoop about what is true and what is not is
called on is identified and reinforced; the focus is still on the not an easy task. The essence of propaganda (encouraging
DB, but a constructional approach is used. beliefs and actions with the least thought possible, Ellul,
A systemic behavior analysis broadens assessment to 1965) is to distort or hide realities. For example, mentalistic
include identification of AABs that can be used to alter the fre- explanations hide controlling conditions (Skinner, 1971).
quency of DBs. Current available repertoires (behaviors the cli- Often, ignorance is intentionally promoted. Hucksters take
ent already has, such as social skills) are transferred to new advantage of hope, fear, and suffering to lure us to buy services
situations. Emotions and thoughts can be used to identify and products that not only may be worthless, but may harm us.
related contingencies. Both this kind of analysis and a non- Pharmaceutical companies hire public relations firms (or use
linear topical analysis are constructional approaches that their own) to plan how to market a drug. For example,
require consideration of what is not occurring, such as for Glaxo-SmithKline hired the public relations firm Cohn and
example positive social contacts. Both offer guidelines for Wolfe to lay the groundwork for the introduction of Paxil
decreasing the DB by improving the cost–benefit ratio of which became a blockbuster drug (Moynihan & Cassels,
AABs. Target behaviors (those focused on to change) are 2005). First on the plan was to create and position the diagnosis
selected based on a review of the costs and benefits associated of ‘‘social anxiety disorder’’ (formerly known by the more
with DBs and AABs. Target behaviors should ‘‘depotentiate’’ benign term as social phobia) as of great prevalence and
(decrease the likelihood of) costly DBs; they should be less concern. Fines against pharmaceutical companies for illegal
costly than the DB and provide more benefits to both the client promotion of products, ‘‘sham advisory boards,’’ and mislead-
and significant others. A target behavior could be on-task beha- ing journal articles, are in the billions as illustrated by the
vior encouraged by providing instructional tasks that engage $3 billion fine against GlaxoSmithKline for unlawful practices
the student’s attention. Notice that in plans based on a systema- (Roehr, 2012). Professionals are supposed to help; they want to
tic analysis, the conditions that ‘‘potentiate’’ a reinforcer, such help. This alone may result in use of interventions that are
as escape from boring or overchallenging material, are harmful or unnecessary. The first conference on avoidable use
removed; there is no need to escape because the instructional of unnecessary interventions was held in April 2012.
material now engages the students. A constructional analysis We should help both clients and professionals to detect
requires information about AABs (Goldiamond, 1974, 1984; misleading claims which contribute to avoidable suffering.
Risley, 1996). It may require observation in real-life settings. These include bogus claims of knowledge (and ignorance),
134 Research on Social Work Practice 23(2)

about risks, effectiveness of interventions, prevention, and often mean by applied. We mean every form of countercontrol
accuracy of diagnostic instruments (Gambrill, 2012a). Accu- typically under the stimulus control of problem displays and
rate understanding of the scientific method is needed to distin- explanations’’ (p. 315).
guish between helpful and trivializing or bogus uses of this As suggested earlier, many parties hide what is done to what
approach. Bogus uses include reliance on scientific ideology effect at what cost and related controlling contingencies (e.g.,
to reaffirm and maintain current definitions or problems and who makes money by providing ineffective or harmful services
service delivery systems that may, in reality, hinder rather than (products) to clients/students). We should identify these parties
enhance the quality of life for clients. Classification of clients and use a contingency analysis to plan how to alter programs so
into psychiatric categories lends an aura of scientific credibility that more clients and students receive more effective programs.
to this practice, whether or not there is any evidence that this is This will be a complex analysis at many levels including pro-
warranted or that it is helpful to clients in meeting their needs. fessional education, institutional settings, and managed care
There has been a rush to premature dubbing of interventions as policies. This descriptive analysis will suggest entry points for
‘‘evidence-based’’ which do not warrant this term (e.g., see change. In the face of overwhelming countercontrol by those
Gorman & Huber, 2009). involved, we must look elsewhere to encourage change such
We should help all involved parties to become aware of the as exposure of the harmful effects and waste of continuing to
flawed nature of peer review and related consequences includ- provide ineffective education and clinical services and related
ing wasting money on ineffective programs. Ioannidis (2005) deceit, greed, and indifference. (See section on revealing
argues that most biomedical research findings are false (see avoidable suffering.) A programmatic approach (as illustrated
also Ioannidis, 2008). Seventy percent of cancer studies cannot in some school and community-wide positive behavior support
be replicated (Begley & Ellis, 2012). Retractionwatch.org posts (PBS) systems and their dissemination) provides a guide (e.g.,
retractions of research reports because of misconduct including Sailor et al., 2009; See also Biglan, 1995).
fraud (See also Fang, Steen, & Casadevall, 2012). I find that
few of my colleagues are aware of the International Congress
on Peer Review and Biomedical Research that has been meet-
Use More User-Friendly Language
ing for years to discuss and address problems of peer review. Baer and his colleagues (1987) emphasize the role of language
Being on the lookout for propaganda in the professional litera- as an impediment to the wide dissemination of behavioral
ture is especially important since our guard may be down, per- methods. ‘‘The past 20 years have shown us again and again
haps because a journal uses peer review; readers may not be that our audiences respond very negatively to our systematic
aware of problems with peer review. When people discover explanations of our programs and their underlying assump-
they have been fooled they do not like this, especially when tions, yet very positively to the total spectacle of our pro-
being fooled has been costly in terms of money or other kinds grams—their procedures and their results—as long as they
of harm, including lost opportunities to help clients. So we are left ‘unexplained’ by us’’ (pp. 315–316). They suggest lan-
should devote great attention to revealing harming in the name guage options to maximize our effectiveness (See also Bailey,
of helping as a result of propaganda and other kinds of mislead- 1991; Lindsley, 1991). Clear writing and engaging, detailed
ing activities including misdirected education. We should blow descriptions of the use of effective methods to resolve real-
the whistle on endless marker variable research in place of pro- life concerns will encourage dissemination (e.g., Pinkston &
gressing on to experimental methods. Linsk, 1984). We could pass all discourse through a special
‘‘wordsmith program’’ guided by Don Baer’s crystalline prose
style. This alone may double our readers.
Use Our Conceptual Analysis and Related Technology to
Enhance Use of Effective Methods
If behavior always makes sense, rather than complain about
Draw on Research Regarding Dissemination
countervailing contingencies, we should take advantage of con- Many fields, including public policy and social psychology
ceptual knowledge and related technology to understand and (e.g., research on persuasion and conformity) and the experi-
alter countervailing contingencies. Obstacles and failures pro- mental analysis of behavior, contribute to exploring the ques-
vide a guide for planning. Baer and his coauthors (1987) sug- tion: ‘‘Under what circumstances does behavior change?’’
gest that the decades between 1967 and 1987 ‘‘have not including. Gaps between knowledge available and what is used
yielded a better public analysis of effective problem display to enhance quality of life has been of key interest in health care
and explanation . . . At best, they have shown us that we need (e.g., Kitson & Straus, 2009). For example, the time between
analyses of (a) displaying and explaining problems so as to gain symptoms of a heart attack and arrival at the emergency room
effective use of the media, (b) controlling the behavior of those (ER) is important. Thus, we can ask what percentage of patients
other people who can function as decision makers’ constituen- arrive at the ER within a certain time. If this is not optimal
cies (i.e., lobbying), (c) having or being able to recruit cam- (which it is not), we can then identify controlling conditions
paign support, and (d) recognizing events called crises as the of timely arrival. We can use this information to arrange for
setting events when those repertoires will be most effective . . . a higher percentage of timely arrivals. Consider also what hap-
those analyses are necessary to understand fully what we most pens when patients arrive at the ER. If timely use of a certain
Gambrill 135

treatment improves chances of living, we can ask: What per- Create and Maintain an Engaging Website Showcasing a
centage of patients at what different hospitals receive this treat- Science of Behavior
ment in a timely manner? We can then identify the controlling
conditions for disseminating and maintaining ‘‘best practices.’’ Compare the current website of the Association of Applied
If half of all doctors are below average, what is the case for Behavior Analysis International with what could be on this site
social workers (Poloniecki, 1998)? If half of patients in inten- in terms of encouraging use of effective methods. Possible
sive care receive suboptimal care, what would we find in social (currently missing) components include the following:
work agencies (Kmietowicz, 2005)? There is an extensive liter-
ature describing gaps in use of knowledge and efforts to make A ‘‘Have You Been Fooled/Bamboozled?’’ Section. The
use of available knowledge (e.g., Straus, Tetroe, & Graham, goal of this section would be to enhance people’s skills
2009). This literature describes obstacles and suggests opportu- in detecting common ways in which they are fooled and
nities. Obstacles include those discussed earlier in this article. to enhance skills, including contingency analysis skills,
Organizational cultures and climates may discourage to decrease their odds of being ‘‘taken-in.’’
change including a preference for authority-based decision A ‘‘What’s Missing?’’ Section. Propaganda in the helping
making—what an administrator dictates. Practitioners may professions appeals to oversimplified views of life experi-
lack access to important resources such as databases needed ences; ‘‘It’s in the brain’’; ‘‘It’s in the genes’’; ‘‘It’s
to make informed decisions (e.g., Gray, 2001; Palinkas & Soy- caused by our thoughts.’’ Asking ‘‘What’s missing?’’ is
dan, 2012). We should draw on related literature to discover valuable in avoiding misleading oversimplifications. A
options (See also Atkins, Siegel, & Slutsky, 2005; Bambara, ‘‘What’s missing? ’’ section could include examples of
Goh, Kern, & Caske, 2012). Under what circumstances will incomplete assessments. The more we can make our
behavioral accounts replace mentalistic approaches that are not examples like a detective story, the more likely people are
effective? We can seek information about why ABA has been to engage with the material. Detective stories present a
successful in some contexts and not in others. For example, use problem—who did it? We could ask, ‘‘What is wrong
of ABA with children with developmental disabilities has been with this picture?’’ Failure to recognize environmental
encouraged by lobbying efforts of their parents. Parents discov- influences is a key reason distortions and misrepresenta-
ered important knowledge and advocated for its use. An educa- tions of ABA and radical behaviorism are so common.
tional approach for communicating with policy makers is If such influences were more vivid, their role would be
advocated by Bogenschneider and Corbett (2010) in which the more difficult to disregard, including contingencies
aim is to inform policy makers rather than to influence them, related to behaviors that could successfully compete with
including informing involved parties about both what is those complained of. We could include a weekly example
‘‘known’’ and what is not and separating fact and opinion. Fair- challenging readers to test their skills in functional anal-
ness of presentation is emphasized. ysis and learn the answers in a later communication.
A ‘‘See For Yourself’’ Section containing video clips illus-
trating application of basic behavioral principles designed
Involve Consumers/Clients to enhance behavioral literacy (e.g., see Carr & Fox,
2009). This would include links to sources illustrating
Engaging consumers in closing knowledge gaps is a key route effective applications of behavioral principles such as
to taking advantage of ABA to enhance quality of life. Use of ‘‘It’s Me or the Dog,’’ a popular TV show in which Vic-
ABA has increased in some areas due to advocacy efforts of toria Stillwell illustrates the application of basic beha-
clients and significant others as suggested earlier. There is a vioral principles to pet behavior problems, which, as
rich literature in evidence-informed practice describing ways would be expected in a behavioral approach, are linked
to involve consumers (e.g., Coulter & Collins, 2011). We can to human behaviors. She focuses on the use of positive
refer clients to Cochraneconsumers.org and include clients in reinforcement, stimulus control, and shaping to encour-
conference presentations. Clients’ views of the value of out- age hoped-for changes.
come differ from clinicians’, thus it is vital to gather these A ‘‘Neglected Successful Programs’’ Section highlighting
views (Basch et al., 2009). effective programs and policies that are ignored such as
the decriminalization of all drugs in Portugal in 2001 (see
Hughes & Stevens, 2010; Redmond, 2012; See also Chap-
Combine Efforts: Birds of a Feather Flock Together man & Mackenzie, 2010). We could describe classic studies
Fragmentation of efforts across many different associations which illustrate underused effective interventions. To how
may dilute effective dissemination (e.g., see Critchfield, many communities has the Juniper Gardens Children’s
2011). Becoming insular is always a danger in terms of lost Project been disseminated (e.g., Greenwood et al., 1992)?
opportunities to enhance the quality of clients’ lives. In addi- A ‘‘Valuable Resources’’ Section linking readers to other
tion to separate associations and other kinds of groups, efforts valuable websites such as PharmedOut.org, DUETS,
should be combined in effective dissemination (e.g., see PBS— healthyskepticism.org, fallacyfiles.org, and www.
Kansas Logic model, Freeman et al., 2010). cochraneconsumer.org
136 Research on Social Work Practice 23(2)

A ‘‘Self-Experiment’’ Section describing valuable self- past the clutter of hundreds of theories/remedies. One life
experiments others have conducted including past uses choice is whether to see misery in people’s lives and how much
of self-management methods (e.g., see Roberts, 2004; Sil- or to turn away. All great religions address this issue and urge
verman, 1986). us to take a stand against inhumanity and avoidable suffering.
A ‘‘Useful Apps and Games’’ Section. Games could depict But there is many a slip between the call and the action pro-
different kinds of contingency analysis challenges and pelled in part by the profit and the prophet motives (Jarvis,
possible approaches and provide repeated opportunities 1990). The eyes may grow weary of seeing plights that appear
to model valuable questions such as ‘‘What’s missing?’’ unsolvable. However, professionals are obligated by their
‘‘Who says so?’’ ‘‘Is it true?’’ Apps designed to enhance codes of ethics to see and to take action to decrease avoidable
observation and propaganda detection skills can be noted. suffering. Only if we expose waste and avoidable miseries,
Comparison of a computerized cognitive behavioral self- including those due to neglect of methods that can help people
help intervention using a game format with intervention to increase their quality of life, are we likely to make more
as usual, found the former to be more effective in headway in closing gaps. We can draw on a science of behavior
decreased depression, anxiety, and hopelessness among to discover and alter relevant conditions. Some say that beha-
adolescents (Merry et al., 2012; see also www. viorists are optimists. Here is a view by Don
healthit.gov).
An ‘‘Opportunities to Meet Birds of a Feather’’ Section (e.g., Some of us have ignored both the thesis that all persons are
listing of conferences and training opportunities, special educable and the thesis that some persons are ineducable, and
interests groups). instead have experimented with ways to teach some previously
A ‘‘What’s new?’’ Section alerting viewers to new books/ unteachable people. Over a few centuries, those experiments
websites such as Addiction: A disorder of choice by have steadily reduced the size of the apparently ineducable
Heyman (2009). group relative to the obviously educable group. Clearly, we
have not finished that adventure. Why predict its outcome,
when we could simply pursue it, and just as well without a pre-
Conclusion diction? Why not pursue it to see if there comes a day when
there is such a small class of apparently ineducable persons left
Disseminating knowledge that contributes to enhancing quality
that it consists of one elderly person who is put forward as
of life is of interest in all helping professions. The history of
ineducable. If that day comes, it will be a very nice day. And
medicine is replete with lost opportunities to avoid harm and
the next day will be even better. (D. M. Baer, personal commu-
to help people. This is also true in the interpersonal helping nication, February 15, 2002 in Heward, 2013, p. 16).
fields of psychology, psychiatry, social work, and counseling.
The history of ABA is filled with creative applications of basic We can take advantage of a science of behavior and related val-
behavioral principles that have helped people to enhance the ues to design and disseminate programs that help people to
quality of their lives. Let us make these histories more visible enhance the quality of their lives. Don Baer likened behavior
in terms of gaps between what was done and what could have analysis to a tree with nodes some of which form a branch and
been done. How often do we hear ‘‘If I had only known.’’ Baer some of which flourish. Let us nourish these nodes in a user-
et al. (1987) suggest that ‘‘effectiveness for the future will friendly manner informed by a science of behavior.
probably be built on system-wide interventions and high-
quality failures, as we continue to bring theory to the point of Author’s Notes
designs that solve problems’’ (p. 325)—a very Popperian
This article was presented as the inaugural Don Baer Lecture at the
(1994) view of the growth of knowledge. They suggest that the
annual conference of the Association for Behavior Analysis Interna-
most important remedy of all, ‘‘will be to establish the proper tional, on May 26, 2012, Seattle, WA. This paper was invited and
context in which to respond to failures’’ (p. 324). They also accepted at the discretion of the Editor.
raise the question as to whether technological failure is the
same as theoretical failure. ‘‘We should expect a long period
Declaration of Conflicting Interests
of difficult, expensive, repetitive, and sometimes ineffective
The author declared no potential conflicts of interest with respect to
research into these applications, and we should enter that
the research, authorship, and/or publication of this article.
research with our best social skills, because we shall require the
cooperation of unusually many people, often in unusually
exposed positions. However, even with relatively little Funding
reaction-to-failure work behind us, it seems clear that we can The author disclosed receipt of the following financial support for the
do it’’ (p. 325). research, authorship, and/or publication of this article: Hutto Patterson
Let us reveal situations in which use of ABA would mini- Charitable Foundation.
mize lost opportunities to help clients. Environmental varia-
tions are increasingly recognized as vital even in gene Note
expression as can be seen in the burgeoning field of epigenetics 1. Dr. Pinkston, a superb scholar and delightful human being, died a
(see also Plomin, 2011). Let us help all involved parties to see few days after this lecture was given.
Gambrill 137

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