SOLUTION: McGill Wk 1 University Regulating Behaviors and Cognitive Counselling Discussion

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Understanding Complex
Behaviour
Cognitive Counselling
Cognitive Counselling or
Cognitive Therapy
• an approach used by psychologists to assist the
person to understand their own behaviour in a
practical, rational way.
• Traditionally, this approach would not have been
used with people who have an intellectual
disability.
• Lovett used this approach by asking:
“if I were this person with these life experiences, why
might I be acting this way?”
Theory of Cognitive Counselling
Cognitive Counselling or Cognitive Therapy typically
involves:
a) the assumption that the difficulties in our lives – such as
depression, anxiety, or panic – have their roots in irrational or
distorted beliefs about ourselves;
b) the belief that by trying to address our ‘irrational’
thoughts and the effect they have on our lives – we can come
to manage and understand our experience;
c) the practice of re-evaluating and re-thinking our irrational
ideas and replacing them with new perspectives and
experiences. As new experiences replace the old negative
ones – we can begin to redefine who we are as a person.
1
Lovett’s Use of Cognitive Counselling
• Explored the deeper meanings that behaviours might be
indicating.
• Wanted to understand more about how the person was
understanding their own behaviour.
• Often the individuals he worked with could not verbally
describe their thoughts or experiences.
• Lovett would try to place himself in the person’s shoes and try
to imagine what past experiences and perceptions might lead the
person to respond with their particular behaviour.
• He did not assume that the ‘behaviour’ was simply a result of
disability. He assumed that – anyone – whether they had a
disability or not – would probably act in the same way if they’d
gone through the same things.
• The person’s ‘behaviour’ was thus attributed to a human
experience, not a disability experience.
Understanding Complex
Behaviour
Social Context
The Effect of the Social Environment
• Common experiences differ from mainstream citizens:




social devaluation;
institutionalization;
lack of economic, educational, and social opportunities;
diminished acceptance….
• As a society, we have not made it very easy for someone with a
disability to achieve the things that his or her peers take for
granted.
• These factors influence the way people express themselves.
We need to more fully understand the social situation of the
people we support. We need to try to understand the behaviour
in the same way that the individual understands the behaviour.
Lovett would remind us that, in some way, the
behaviour is adaptive, or makes sense to the person.
2
The Result of Not Feeling Valued
• Four goals that motivate people and help to gain a
sense of belonging or of being needed within a
group or community:
• Attention
• Power
• Revenge
• Displayed Inadequacy
Rudolph Driekers
Lovett’s Strategies – Attention
• “Attention-seeking behaviour”
• Implies that wanting to be noticed is a
mysterious or bad need.
• Wanting attention is a normal, human need.
• If someone is acting like they need attention – the way
to address this concern is to give the person attention.
• It is always best to give someone attention sooner
rather than later: by doing this the person does not
have to do increasingly dramatic things to get our
attention.
Lovett’s Strategies – Power
• People with disabilities often have little power
(control) in their lives.
• Schedules, activities, companions, staff, where to
live & spend the days etc. are chosen by others.
• Power is the strength to be self-determining.
• If a person feels powerless, or if they do not have
opportunities to make their own decisions, they may
assert their need for power in any way they can. This
can lead to power struggles.
• This could be labeled “manipulative”
3
Lovett’s Strategies Displayed Inadequacy
• Sometimes a person may feel that they are unable
to do something – even though everyone else feels
they can and should do it.
• This can be labeled “non-compliance”
• If a person seems unmotivated – they need
Encouragement, Encouragement, Encouragement,
and more Encouragement.
Lovett’s Strategies – Revenge
• A person who wants to get revenge feels hurt and
wants to retaliate. This is the strategy one might
take in order to fight back.
• This could be labelled as “aggressive”, but it
relates to feelings of hurt.
Lovett’s Strategies – Final Thoughts
Competence as Motivation:
• When a person gains competence or skills, it
supports the development of self esteem and
confidence.
• When the person uses these skills to help others, it
reinforces that everyone has contributions to
make.
• Underlying theme in Lovett’s work – a person’s
behaviour is a way of letting us know how they
feel, and that they let us know this by making us
feel the same things that they feel.
4
Social Context and Behaviour
Questions to consider:
• Is the issue one of material poverty?
Does the person simply want the same things that
everyone else has?
• Is the issue one of power and personal choice?
Who really makes most of the decisions in this
person’s life?
• Is the issue one of loneliness?
Does anyone love this person? Are there friends and
loved ones in this person’s life?
• If the person did not have a disability how would we
interpret his or her behaviour?
Understanding Complex
Behaviour
Self-harm
Self-injury and Social Context
Self-injury is…
• not related to having an intellectual disability but, rather,
to coping with very difficult life circumstances.
• not attention-seeking behaviour, but rather a way to
express pain when other means of communication are not
effective – an attempt to deal with intense, intolerable,
negative emotions.
• more likely to be practiced by a person who experiences
social prejudice.
Self-injury Outreach & Support,
McGill University
5
Self-injury and Social Context
• Be responsive – this is communication – give
attention, do not ignore!
• Rule out potential medical causes
• Determine when it is occurring/not occurring to
find possible environmental causes (Hingsburger)
• Rearrange the natural environment – respond to
the person’s need – more/less engagement,
structure-routine/ freedom, new activities/avoid
changes
Renee Fucilla Ristic
6
Understanding Complex
Behaviour
Behaviourism
Concepts of Behaviourism
• Behaviourism is rooted in the work of Ivan Pavlov and B.F.
Skinner in the 1920’s and 1930’s.
• Pavlov developed the theory of Classical Conditioning in which a
behaviour that originally followed one stimulus as a reflex
connection; is made to follow another previously unrelated
stimulus. The most familiar example of this is Pavlov’s dog. Here,
a dog that normally salivates when food is presented, is
conditioned to salivate to the sound of a bell.
• B.F. Skinner built on this work and developed a theory call
Operant Conditioning. This is the belief that the consequences
following a behaviour influence the chance of the behaviour
being repeated in the future.
Operant Conditioning
• Antecedent – what happens prior to the behaviour
• Behaviour – what the person does in response to
the behaviour
• Consequence – what happens after the behaviour
occurs
• Implication – the likelihood of the behaviour
repeating itself.
1
Behavioural Principles:
Reinforcement and Punishment
Reinforcement increases a behaviour.
 Reinforcement: can be positive (by adding something pleasant or positive
to the person’s experience)
Susan will receive a chocolate bar if she sits quietly in church ƒ
 Reinforcement can be negative (by taking away something negative)
Susan had a sliver in her foot. Her screaming stopped when her mother removed
the sliver.
Punishment decreases a behaviour.
 Punishment can add something to the person’s experience (this could be
something unpleasant or unrewarding):
Susan was sent to her room for being noisy in church
 Punishment can be negative (by taking away something pleasant)
Susan had her TV watching time reduced because she kept hiding the remote.
Brain-related Concepts of Behaviour
• Nathan Ory – behavourist also interested in “why”
something is happening
• For some individuals with intellectual disabilities,
the brain may function in ways that influence
behaviour differently from individuals who do not
have intellectual disabilities.
**be cautious not to assume this of all people with
a disability.**
• Review Understanding Distraction and
Inattention, p. 21
Concerns about
Behavioural Approaches
• The use of aversives, Judge Rotenberg Centre.
• The Milgram Experiment
2
Understanding Complex
Behaviour
Introduction
Behaviour of Concern…
and Our (Historical) Approach
• What are “problem” behaviours
• Historical responses
• Institutionalization
• Harsh treatment, deprivation
• Behaviour Plans and Interventions done “to” rather
than “with” the person
Behaviour Of Concern…
and Cur rent (More Desired) Approach
• What is a behaviour of concern? 5 Ws
• Background – our perception of the behaviour and the
information we’ve learned.
• What behaviours of concern have you witnessed by a
person you support?
• What do you think the person was thinking?
• Why did the behaviour occur?
1
What Behaviour is Concer ning?

• Is someone being hurt by this behaviour, i.e., the person
themselves, or someone else?
• Does the behaviour present the individual to the rest of
the community in a negative way?
• If this behaviour continues, will it push others away from
this person?
If the answer to these questions is ‘yes’ then it may be
important to think about meaningful ways to help the
individual address his or her behaviour.
UNDERSTANDING
COMPLEX BEHAVIOUR
Background
To begin, we need to
know our histor y…
• In the past, people with disabilities did not live in
community.
• Many people with disabilities were institutionalized
or were kept in their family’s homes, away from the
public.
• As a society, we don’t have much of a history and
experience living with people who have a disability.
2
INSTITUTIONALIZATION AS THE
“NORM”
• Institutionalization began in the 1850’s and reached it
highest prominence in the 1970’s
• goals of training
• saw potential for people to be contributing members of
society
• Training was replaced with management and control by
professionals
• Institutionalization is a common experience shared by
people who live with a variety of disabilities
• This model still exists
WHAT DO WE MEAN BY “DEVIANT”
• A difference that is negatively valued by society
• If a person is seen to be “too different”, our response was
to institutionalize them.
• Since the decline of institutionalization in the late 1970’s, more
and more people with disabilities are living in community.
• Now, we are trying to create different, more inclusive ways to
respond to the behaviour a person my express.
• Society is learning to understand “difference”. This
takes time and we need to be aware that many people in
society are still familiar with the institutional approaches to
difference or, as some may say “deviance”.
OUTCOMES OF INSTITUTIONAL PRACTICES
• Management and control in the form of
“Professional Dominance” is still very common.
• Staff sometimes think their job is to make the decisions or
control the people they are meant to support.
• The impact of living in an institution is not easily forgotten.
• People experience long-term (often life-long) memories, fears
and trauma resulting from institutionalization.
• Expecting people to “get over it” is insensitive and unrealistic.
• Even when supported in community, people with disabilities
may continue to be negatively impacted by “institutional
mentality”, if their staff are focused on management and
control.
3
Community Living – A new concept
• The predominant model of support since the 1980’s.
• In the grand scheme of things, that’s very recent.
• We are still learning how to live with people who have a disability, as
well as people who have a broad range of life experiences.
• Institutional models of control have followed people into community.
• When people left institutions, their behaviour plans came with them.
So, they were still living under control in the new setting of
community. There is evidence of this institutional mindset in our
residential and day services still today.
• This is meant to offer context and to help you understand why our
supports to people are still evolving. Change takes time. You have the
opportunity to be an important part of the change if you take these
course topics to heart.
The Nature of Behaviour
Understanding Complex
Behaviour
WHERE DOES BEHAVIOUR COME FROM?
• Nature vs. Nurture Debate
• Nature – a person’s behaviours are part
of who they are.
• Nurture – a person’s behaviours are
the result of their environment.What a
person experiences impacts them.
Each person may be impacted in unique ways.
• Social Context
• A range of ability and behaviour is to be expected in society (as
people, we have commonality and we are also unique).
• The disability lies within society’s inability to accommodate
diversity/difference.
4
The Intention Behind Behaviour
Deliberate
• Is the person intentionally doing something on purpose?
• If behaviour happens for a reason
and it is intentional, how do we view
that?
No Control
– Does this happen by accident, is the person unable to
avoid this behaviour for some reason?
– Is the person unaware of the impact of their
behaviour?
WHAT IS THE REASON FOR THE
BEHAVIOUR?
• Why is the person doing this?
• Do you feel the person is trying to bug you? “I just want this
to stop?”
• Do you want to know why the person is doing something in
order to help them?
• All behaviour is communication.
• There is a growing belief that all behaviour is a form of
communication.
• The person is trying to get their point across.They are not
trying to bug us.
• What happens if we respond? What happens if we ignore?
Considerations in Addressing
Behaviour
Hingsbuger, D. (1996). Behaviour Self.
Eastman, Quebec Diverse City Press
5
Considerations in
Addressing Behaviour
1. All behaviour communicates and those who wish to help people
with behavioural problems, must see behaviour as a legitimate
language that needs decoding.
2. Unethical programming occurs when a professional attempts to
program away a behaviour without understanding its meaning is
unethical. We don’t need to be right, but we need to have tried to
interpret the language.
3. When we design programs around someone’s behaviour we must
always leave the individual with a disability in more control of their
LIVES – not just their behaviour.
4. When a behaviour plan or program is unsuccessful, blame the
hypothesis (theory). Don’t blame the individual with a disability or
the support people.
Considerations in
Addressing Behaviour continued
5. People with disabilities are complex, just like people without
disabilities. They require a broad range of service options –
including a variety of support and therapies.
6. Medication is not bad – it should not be used to control a person
but to assist them with control.
7. Support personnel who try to understand behaviour may find
that the behaviour often communicates about an inappropriate
environment or inappropriate treatment. You may need to
become an advocate and speak up about what else isn’t working.
8. Don’t try to make everyone the same. Behavioural support is not
designed to make everyone the same. Using behaviour
technology to eradicate personal difference and personal choice
is an Aryan* concept.
Causes of Behaviour
 Six Possible Factors to Explore,
David Hingsburger
6
Causes of Behaviour
1. Medical Factors – The individual may be experiencing a
physiological or medical condition.
2. Medication – The side effects of medications may lead to a variety
of atypical behaviours.
3. Psychiatric Factors – People with intellectual disabilities are
complex (just like everyone else). Some individuals may have both
an intellectual disability and an emotional or psychiatric disability.
This is sometimes described as a Dual Diagnosis. Often the
individuals we support are Survivors of traumatic experiences
Causes of Behaviour continued
4. Significant Life Changes – Changing places, changing roles, and
changing relationships are all significant live changes that can be very
difficult to cope with. The person may need time, support to feel
secure, assistance to develop coping skills.
5. Life Space Analysis – Examine whether the person is physically in
the ‘right’ place by asking Is this really where this person wants to live? Is
this the job or day program the person desires? Are these the people this person
enjoys being around?
6. Interactional Support – When someone is having a difficult time,
interaction with the people who care most about the person has a
tremendous impact. People with disabilities need an array of people
in their lives (not just professionals). Assist the person to build
connections with people who care about them.
W ho, W ha t, W hen, a nd W here of Behavi our
Who
• Who is present when this behaviour occurs?
• Does the behaviour occur more often when a particular person is present?
• Is the behaviour directed toward anyone?
What
• What is happening when the behaviour occurs?
• What were other people doing at that time?
• What is happening when the behaviour does not occur or is less likely to occur?
When
• Examine when the behaviour does and does not occur
• Is there a time of day or during a certain part of daily routines when it happens?
• Within a certain activity, does it happen at the beginning or end or during transition?
Where
• Where does the behaviour happen most often?
• Where specifically in this location does the behaviour occur (what part of the room)?
7
M otiva ti on a nd Unmet Need s
FOLLOW UP FROM CLASS
1.Create your journal reflection document and share the link
with me.
2.Write your journal entry for today’s class.
3.Spend some time choosing which Student-led Assignment
option you are going to submit. Complete one action to
get the assignment started.
4.Post a question for next week’s guest speaker.
8

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