Bettelheim_Skinner_Kautzy_Merkl by fjzhangxiaoquan


									 Jenny Kautzky
    Matt Merkl
Mary Hulseman
   Autism: a developmental disorder that is
    characterized by the impairment of the ability
    to communicate with others
   Bettelheim believed that “although autistic
    children are solipsistic as infants in their
    contact with reality, and communicate as
    little, they are much farther developed in
•   Interested in psychology but earned his degree
    in philosophy at the University of Vienna
•   A Jew living in Austria, he spent 11 months in
    concentration camps then was released
•   Married and went to the U.S. where he became
    a professor of psychology
•   Director of the Orthogenic School in Chicago,
    where he housed and treated many cognitively
    impaired children
•   Suffered from depression and ultimately
    committed suicide after his wife died
   He believed that “the lack of satisfying
    responses from those who take care of him
    may force the infant too early to view the
    world as purely frustrating.. [this view] will
    not impel him to invest vital energy in
    reaching out for what he wants, even when
    his growth development makes that possible”
    (The Empty Fortress)
   Encouraged the counselors to conduct
    „marginal interviews‟ with the children in
    which the counselor clears up any anxiety
    that the child has in order for them to
   Interpretative character; did not interfere with
    the activity of the child
   Ego-supporting
 “therapeutic effort, taken singly or added up,
  cannot easily achieve what is done through
  the integrated efforts of a total staff; but the
  condition for such work is a pattern of group
  living that is harmoniously concerted without
  any single voice losing its independent
  character.. The individual uniqueness must be
  preserved within the unity of living if any
  success is to be achieved”
(Love is Not Enough)
•   Aimed at “eventually giving the child the feeling
    that we believe that neither he alone nor we
    alone can solve his basic problems, but that he
    will be able to solve them with our help in a
    process of daily living together” (Love is Not
•   Avoid any efforts to discuss the child‟s problems;
    allows the child to rely on actual daily activities
    he can participate in or watch in order to make
    his own judgments of the school
•   Different attitude towards money and activities
•   Born in Pennsylvania and attended Hamilton
    College (where he worked in the lab of an
    experimental biologist) and Harvard
•   Using pigeons and rats he developed his
    notions of “operant conditioning” and
    “shaping behavior”
•   Taught at Harvard while he published several
    books such as Science and Human Behavior
    and Beyond Freedom and Dignity; he died in
•   Gives a scientific analysis which shifts both
    the responsibility and the achievement to the
•   “Operant” behavior
•   Negative/positive reinforcements and
•   “Our task is not to encourage moral struggle
    or to build or demonstrate inner virtues. It is
    to make life less punishing” (Beyond Freedom
    and Dignity)
   We hypothesized that there would be some of
    Bettelheim‟s notions of the importance of the
    individual in therapy, but that the treatment
    would deviate from Bettelheim‟s
    developmental approach in that the
    therapists incorporate some elements of
    behavior modification rooted in Skinner.
•   We wanted to look at the implications of
    Bettelheim and Skinner‟s work in modern
    therapy practices. We observed PTs and OTs
    at Baylor OCH as well as ECI in order to
    collect data.
•   Baylor OCH is an outpatient clinic; ECI is an in
    home therapy program
“Our Children’s House at Baylor is a
licensed pediatric hospital where
care is comprehensive and healing is
fun. Here, children from infancy
through age 18 receive care for
developmental or birth disorders,
traumatic injury and severe illness.
OCH at Baylor offers specialized
pediatric therapy at our nine
outpatient therapy clinics located
across the DFW Metroplex.”
“ECI is a statewide program for families with
children, birth to three, with disabilities and
developmental delays. ECI supports families
to help their children reach their potential
through developmental services. Services are
provided by a variety of local agencies and
organizations across Texas.”
      1) Is therapy more child-centered or therapist-directed?
•     Bettelheim:
•   “They have to protect as their own, by not beginning to “do” when we would like
    them to, but only in their own good time.”
•   (The Empty Fortress; Infantile Autism and the Birth of the Self)
•       Skinner:
•   “To refuse to control is to leave control not to the person himself, but to other parts
    of the social and non-social environments.”
•    (Beyond Freedom and Dignity)
•          2) Does the therapist let the session play out regardless of the child‟s
    behavior or try to change the behavior using their actions or words?
•    Bettelheim:
•   “They have to make sure innumerable times that nothing is being forced on them,
    that it is they who want to eat, to move their bowels, to play or do anything,
    including talk.” (The Empty Fortress; Infantile Autism and the Birth of the Self)
•     Skinner:
•   “Guidance is effective, however, only to the extent that control is exerted. To guide
    is either to open new opportunities or to block growth in particular directions.”
    (Beyond Freedom and Dignity)
•         3) Regarding the interaction between the therapist and patient, is there an
    effort to change the attitude of the patient or merely the behavior?
•     Bettelheim:
•   “Only after a period of soiling or not dressing themselves do they relearn such a
    skill, but now within a more positive relationship and as part of a developing self-
    to gain a sense of well-being.” (The Empty Fortress; Infantile Autism and the Birth of
    the Self)
•     Skinner:
•                        “We change behavior toward something, not an attitude toward
    it.” (Beyond Freedom and Dignity)
                   Bettelheim 1    2     3      4    5      6 Skinner
            Patient 1       Patient 2   Patient 3    Patient 4 (3
            (10 yr M)       (10 yr M)   (18 mon M)   yrs F)
            Q1:     2       2               5        5
            Q2:     5       4               5        5
            Q3:     5       4               3        5
1)     Is therapy more child-centered or therapist-
2)    Does the therapist let the session play out
      regardless of the child‟s behavior or try to
      change the behavior using their actions/ words?
3)    Regarding the interaction between the therapist
      and patient, is there an effort to change the
      attitude of the patient or merely the behavior?
     Bettelheim 1       2          3    4       5        6 Skinner
   Most sessions did tend to be child-centered, but
    depends on the therapist.
   Therapists tended to try to change the behavior
    of the child, often with different techniques
    (positive reinforcement/tone/body language etc).
    Child‟s attitude varied each session depending
    on how their day was going
   Most therapists tried to just change behavior and
    not attitude but with the youngest child (Patient
    3), the therapist had to change his attitude to get
    any work done (he was on the verge of crying)
Baylor OCH:
Use of positive
 reinforcement- Wii           ECI:
Lower tone (sensitive           Repetition of
 hearing) attempt to           directions
 keep child “on track”          Constant feedback/
Repetition of directions       encouragement
Outside tools to change         Worked from simple
 comfort level, rather         to complex tasks
 than just letting them
 interact & change on
 their own(as in
 Bettelheim‟s school)
Baylor OCH:                ECI:
Routine                       Approached each
Institution outside of       child as an
 home (without               individual with
 parents)                    needs and a
Child-centered               particular way of
 philosophy                  learning
   Baylor OCH has elements of Bettelheim,
    namely the focus on the individual and
    especially approaching therapy from a “child-
    centered” perspective in an outpatient clinic.
    Baylor OCH therapists tended to use a
    rewards system, especially positive
    reinforcement, in order to modify the
    behavior of the patients, and this reflected
    Skinner‟s beliefs.
   ECI also uses a child-centered approach in a
    home environment in which parents can
    freely interact and learn more about how to
    help improve the development of their child
    between the weekly sessions. ECI uses a lot
    of repetition and positive encouragement,
    without using any forceful tactics or
    attempting to control the patient.
Change in quality of institutions and quicker
 diagnosis of autism
More financial support for treatment
Technological advances such as therapeutic
   Dr. Temple Grandin
    who suffers from high
    functioning autism
    wrote a book that
    changed the way
    people view autism

   (written in 1995)

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