Just a Little Bit Better

Ten years after Braulio Montalvo succeeded Salvador Minuchin at the reins of the Philadelphia Child Guidance Clinic, an interviewer asked him what the biggest difference was in his impressions of family therapy from the early days. He stated that he learned to expect less, that families didn't change as radically as what was hoped for when family therapy was nascent. Yet, what became clear to me after practicing family therapy for two decades, was that small changes in families were often perceived by family members as big.

As a couples and family therapist, I learned to ask a simple question. What is the smallest change that needs to happen in order for you to know that things are getting better?

When people were able to focus on making small changes, they felt better. Change did not have to be daunting, and they could see their accomplishments and feel good about their success.

As behavior analysts, we know this well. We are taught to shape behavior by breaking down complex behavior chains into their smallest parts, and we teach "successive approximations" until the complex behavior becomes seamless.

Can we apply our own methods to ourselves? What if we told ourselves, "what is the smallest change I can make in order to know things are getting better?" Would we choose not to focus on losing 20 pounds, but instead on 2? Would we choose to finally pick up the musical instrument that sits dormant, and practice for just five minutes a day? Would we choose to write one page of our dissertation or that article we have been intending to tackle, instead of focusing on completing the entire project?

I am a sixties (that's 1960's, not 1860's) musical fanatic. I can't help but think of Peter Noone singing the chorus of one of Herman's Hermits great songs: Now ain't that just a little bit better?

Happy Kaizen New Year!

Those of you who have recently been meandering around the hallowed halls of Pacific Child and Family Associates have heard me muttering the word "kaizen" repeatedly under my breath. This is my new mantra. I have been trying to implement this American-born and Japanese-bred management style at Pacific Child, in true kaizen style, little by little over the last couple of months. Things are going great here, and I do believe this approach is a very cozy bedfellow for those of us who call ourselves behavior analysts. It is a method that encourages personal initiative. It is interactive and flexible, creating cycles of creative progress which ultimately lead onward and upward.

So, in the next few blogs, I intend to clue you in on the principles of kaizen and how they apply to what we do.

There are several facets of the kaizen approach, some big ones and some not so big ones. One key element is the focus on making small, measurable change, as opposed to large, radical shifts. Sounds like ABA, yes? We take our baseline, assess the problem, make a plan, measure the outcome, and memorialize the results if they are positive. It is the classic A-B design.

But in this entry, I want to focus on another piece of kaizen philosophy. That is the piece having to do with the importance of taking care of oneself. It is about working hard at what we do, but not so hard that we allow ourselves to get burned out.
In this holiday season let’s pause and consider how self-care gives us more energy to care for others as well. Self care doesn’t mean self-indulgence, or being self-centered. And it’s much more than finally taking that long, slow bath or treating yourself to a massage. Nurturing oneself can also mean embracing the kaizen principle of ‘personal discipline’ as a daily practice. That type of self-care helps us reduce from our lives those things which waste time, energy, space and resources. We find we have more time and more energy.
It’s not about expecting more from oneself than is reasonable. Rather, recognizing that the kaizen elements of effort and quality and can be applied to our own lives as well as our work. Underlying it all is the willingness to change.

Research has shown that the majority of New Year’s resolutions are broken very quickly. The one-shot, sudden approach, no matter how well-intentioned, can fail us. I’m going to look toward 2011 as the beginning of a fresh personal philosophy, inspired by the kaizen method of sustained change which is aimed at gradual improvement in a humane, people-oriented way. I hope to take better care of myself and in so doing take better care of our employees and our clients. Happy New Year.

Rising Stars

Just some words of congratulations on some of Pacific Child's rising stars. Marta Marquez and Hilary Zeller are our newest BCBAs! Congratulations on leaping the final hurdle. Also, I want to congratulate LaDonna Haltom, one of our senior therapists in the Southern California office, for being promoted to a supervisor position. Also, I want to welcome aboard two new supervisors. A warm welcome goes to Laura Simpson, our newest supervisor in the East Bay office, and Andria Hernandez, our newest supervisor in the Inland Empire office. We welcome your commitment and passion and your dedication to providing the highest quality ABA services to our clients. Congratulations to you all, and welcome aboard.

"Go East!"

“Go West, Young Man, Go West!” were the famous words written by Horace Greeley in support of Manifest Destiny. For Pacific Child, this is a difficult calling, because we have been born and bred in the west. So for Pacific Child, our most recent calling is to “Go East!”
I am thrilled to announce that Pacific Child is opening its first office in the Midwest, which to us in California is really the East. Deb Ewen Miller, who has shepherded our Eureka, California office so brilliantly in the last several years, will be running our first office in Duluth, Minnesota. We hope to serve the entire Minnesota area out of this office.
As we embark on our Easterly expansion, I want to thank Deb Miller for her extraordinary work among the redwoods of Northern California. We are truly blessed to have her continue her work with PCFA, and brave the bitter winters, in Minnesota.

Lifelong Learning

There was a phrase I heard constantly throughout my childhood. In the Bronx accent I usually heard it, it sounded like this: “You live and you loyn.” Translation: You live and you learn. It was most often uttered as a way of comforting someone when something happened that wasn’t quite right, kind of like, well, you won’t make that mistake again and it will be alright.

But, as is typical with phrases that hang around for a lifetime, there was a lot more to it than that. Do we, in fact, “live and learn”?

In “The Once and Future King,” T.H. White writes (through the character of Merlyn):

The best thing for being sad… is to learn something. That is the only thing that never fails. You may grow old and trembling in your anatomies, you may lie awake at night listening to the disorder of your veins,… you may see the world around you devastated by evil lunatics, or know your honor trampled in the sewers of baser minds. There is only one thing for it then—to learn. Learn why the world wags and what wags it. That is the only thing which the mind can never exhaust, never alienate, never be tortured by, never fear or distrust, and never dream of regretting. Learning is the thing for you.

For many of us, the product of our education system in the U.S. is to see learning as a chore. It is something we have to do to go from here to there, like an uncomfortable bus ride over pot-holed streets. But in Merlyn’s comforting words learning takes a different form. It is a kind of therapy, a comfort and a solace. It is to some degree a place away from the hectic world of business and rumor, but it is also a powerful tool with which to engage life. Perhaps most importantly it is an antidote to “fear and distrust.” Learning, the pursuit of the truth, guided by a moral compass, leads to compassionate understanding and is a powerful weapon against those “evil lunatics” who, in reality, fail to understand or see the deeper truths.

A Great Loss

O. Ivar Lovaas died just over a week ago at a hospital in Lancaster. He was 83 years old. I did not know him personally, although I spoke with him on a couple of occasions and attended a lecture of his at Cal-ABA on self-stimulatory behavior. To say that Lovaas was an icon is an understatement. Although he was not the originator of the methods that eventually became so associated with him that for many years they were called “Lovaas therapy,” his contributions as a researcher and tireless promoter were huge.
In reality, the methods he used to treat children with autism and others were developed by his mentors at the University of Washington—Don Baer, Todd Risley, Montrose Wolf, and others—methods that eventually came to be called applied behavior analysis. Lovaas was a graduate student at the University of Washington who had been trained in classical psychoanalytic methods, and although he became perhaps the most well-known advocate for behavioral methods for children with autism, he never swayed completely from his psychoanalytic roots. In fact he was probably the only behavioral researcher who gave Rorschach tests to his subjects.
Lovaas was a controversial figure, revered by many and reviled by many others. In his early work, he occasionally used aversive procedures, which he defended adamantly although he eventually abandoned them in favor of non-aversive procedures. He claimed for some time that the only way to achieve the formidable results he achieved was to be trained only by him or those authorized by him, thereby giving a proprietary flair to his methods. In true scientific fashion, many academicians looked askance at anything proprietary, capitalism and science being the awkward bedfellows they can sometimes be.
Those who knew him and were close to him have told me that he was often sweet and charming, but definitely genuine. You knew where you stood with him. In my view, his responses to those who criticized him occasionally lacked sensitivity; he did joke at times that his Norwegian farmer roots led him to say things simply and directly. There can be no doubt that without his contributions, many thousands of children would not have received the help they needed.
In the last few years, he had been diagnosed with Alzheimer’s, and he did not lecture or appear in large public forums. He eventually died of an infection following hip surgery. He was a giant and we will miss him. Most importantly, those of us in the field of helping children with autism owe him a deep debt of gratitude.

Great Perseverance

If we are facing in the right direction, all we have to do is keep on walking. - Buddhist Saying

In my first full-time job as a psychologist, I was lucky enough to have two children diagnosed with autism in my caseload. One of them had participated in Lovaas’ 1987 landmark study, and the other was the subject of a book about a play therapy technique. Both of these children improved dramatically, so much so that the medical director and child psychiatrist at the agency said to me that he thought these children were misdiagnosed. The reason? “They couldn’t have had autism because they got better.”
Prior to the ABA “revolution”, professionals dismissed children with autism as incapable of learning, of “mentally retarded,” because those simple things other children could learn to do quickly, either through simple imitation or quick demonstration, children with autism could not. But those of us who work in this profession know that this is not the case; that skills which may take a “typical” child one or two trials to learn, may take the child with autism one or two thousand trials. Yet they do learn.
The difference between a child with autism growing up to be an adult with autism and a child with autism who may grow up nearly indistinguishable from his or her peers can be boiled down practically to one thing: perseverance. It is the great perseverance of those around them who have the patience to work hour after hour on teaching simple skills. It is the perseverance of the parents who themselves intervene and struggle, minute-by-minute, with the required caretaking and emotional stamina. And ultimately, it is the perseverance of the child him or herself, who works diligently hour after hour, through much frustration in order to “rewire” a neurological system that is wreaking havoc with his or her development.
The “magic” that is ABA is, of course, no magic at all. Those of us who ply that trade have often wondered why it took so long for ABA pioneers to “discover” that simply taking skills and breaking them up into their component parts and training through repetition, prompting and reinforcement could allow our children to break free of the bonds of silence and withdrawal.
Perhaps it is the loneliness of non-functioning in the mainstream world that spurs the perseverance of the child. Or perhaps it is the love and devotion of parents and caregivers, who themselves persevere. But this determination to keep going, to keep trying which method works for which individual and to repeat and repeat until there is progress, turns into a reciprocal experience. We persevere so the child perseveres. When the child perseveres it inspires us to do likewise.
Each child with autism presents a unique set of challenges. But one thing that is shared among most is the sense that change occurs ever so slowly. It is easy to give up in the face of the pain. It is a similar challenge each of us faces when confronted with our own devastations, such as the loss of a loved one, our own diagnosis of a life-threatening illness, or a traumatic life upheaval. At times, the devastation can be so great that we feel as though we are losing our breath.
There are many clichés about what comes next. But the bottom line is that we must take one breath at a time, walk one step at a time, face the right direction and keep moving. We must not lose our great faith, we must hold on to our great doubt as our partner, and above all, we must persevere.