In younger days, whenever a group of pretentious young adults got together for a gathering, it wasn’t long before someone brought up the question: “What is art?” The idea was to try to say something intelligent without sounding too silly, nearly always an impossible task. Eventually someone would say something about art similar to what Supreme Court Justice Potter Stewart said about pornography: that he couldn’t quite explain it, but “I know it when I see it.”
I have taught now for several years at UCLA School of Medicine. Initially the course I tutored was in the first year of medical school, and occasionally I would ask the students whether they thought medicine was a science or an art. Typically in the first year nearly all the students said it was a science. In the second year, however, the students were split more evenly down the middle. I have often wondered where the numbers would be by the fourth year. Real life, I suppose, can transform that which appears at first to follow the linear rules of scientific inquiry into the more mystical realm of art.
It has been said that good art awakens something in us, and becomes the abode of that which we might call “spirit.” Defining “spirit” of course is another party topic, one more likely to be heard these days than the question of defining art. For the moment, let us agree that spirit refers to some sort of essential life-force. It is that force that animates us, drives us to feel alive.
Behavior analysts are trained to believe that a defining characteristic of their profession is that it is a science. It follows logical rules, and decisions are based on data, not intuition or guesswork. The former of course are the domain of science, where the latter tends to reside in the realm of spirit. But I would suggest the opposite: watch a behaviorist at work. The truly good ones are artists. Their work awakens something inside of us, makes us feel alive. Their interactions are like impromptu dances, reacting gracefully and seamlessly to the client’s behavior. The behavior analyst as artist spontaneously creates something beyond the logic of science as she taps into her repertoire and responds with a deep awareness of the child’s needs, wishes, intentions and the environment within which the child interacts. As it is with most art, these results take years of study, years of “science”, years of clumsy, “bad art” to build on.
As the whole is always more than the sum of its parts, the behavior analyst creates something beyond the mere piecing together of the data. She uses those tools as a painter might learn how to mix colors, or which paints or brushes creates a desired effect. But the end result is the creation of something larger than the technical methods could do on their own. A child’s spontaneous smile, a laugh at just the right moment, the uttering of the first meaningful words, the twinkling in a child’s eyes as he discovers something new is an awakening of the child’s spirit. It is an awakening that comes often as the partial result of the creative efforts of the behavior analyst, the artistry and dedication, the creative and yes, even intuitive, dance between the spirit of the behavior analyst and the spirit of the client.
Saturday, March 13, 2010
Wednesday, February 3, 2010
Invisible Rubrics
I have always loved my work, and have said that if ever the negatives outweigh the positives then it is time to reconsider my work life. At a recent supervisor meeting, I asked our supervisors for suggestions on how to make their lives at Pacific Child less burdensome. I wanted to know what they loved about their jobs and what they wanted to see different. Of course it was nice to hear about the positives, but I was concerned that people weren’t feeling safe to talk about the negatives. One supervisor used a phrase that I loved. She stated that she was afraid of the “invisible rubric,” and what I believe she meant was that she didn’t know exactly how she was being evaluated, and therefore carried around a lot of anxiety that what she was doing wasn’t what we, her supervisors, were evaluating her on.
It is always the unknown that frightens us the most, the monster hiding in the closet. And perhaps that is the greatest source of pain that the parents of our children with autism feel as well. The word “autism” originally meant “self-focused,” and focusing on oneself also meant shutting out the rest of the world. But if we truly believed there was no one hiding beneath the cloak of silent withdrawal we wouldn’t care much. It is that view, that there is someone hiding in the closet of our child’s mind that is so taunting. Who is this child? What is he thinking? What does he want? And what does he think of us?
In a strikingly parallel way, it is our children with autism who we believe lack the ability to determine (or even care) how others think of them (“theory of mind”). Our supervisors and staff work diligently to plant and nurture within our children the seeds of knowing and caring how others think about them, yet our supervisors themselves struggle to know what it is that they are being evaluated on, what it is that their supervisors think about them.
We are all evaluated by others, especially by those with whom we are close, continually. “Unconditional positive regard” was the watchword of the sixties, and it was as mythical as unicorns. So we struggle to know what it is that others expect of us so that we can choose freely whether or not we wish to jump through those hoops. But it is those invisible hoops that are the toughest, especially when the hoops are on fire.
So it behooves us all to make the invisible rubrics visible. But that is also a two-way street. When in doubt, ask those for whom we care what they want and expect from us, and let’s not be shy about making the deal go in both directions. Even those doing the supervision wonder and worry about how their supervisees are viewing them. Let us strive toward making our expectations clear, and let’s talk about it often and openly.
It is always the unknown that frightens us the most, the monster hiding in the closet. And perhaps that is the greatest source of pain that the parents of our children with autism feel as well. The word “autism” originally meant “self-focused,” and focusing on oneself also meant shutting out the rest of the world. But if we truly believed there was no one hiding beneath the cloak of silent withdrawal we wouldn’t care much. It is that view, that there is someone hiding in the closet of our child’s mind that is so taunting. Who is this child? What is he thinking? What does he want? And what does he think of us?
In a strikingly parallel way, it is our children with autism who we believe lack the ability to determine (or even care) how others think of them (“theory of mind”). Our supervisors and staff work diligently to plant and nurture within our children the seeds of knowing and caring how others think about them, yet our supervisors themselves struggle to know what it is that they are being evaluated on, what it is that their supervisors think about them.
We are all evaluated by others, especially by those with whom we are close, continually. “Unconditional positive regard” was the watchword of the sixties, and it was as mythical as unicorns. So we struggle to know what it is that others expect of us so that we can choose freely whether or not we wish to jump through those hoops. But it is those invisible hoops that are the toughest, especially when the hoops are on fire.
So it behooves us all to make the invisible rubrics visible. But that is also a two-way street. When in doubt, ask those for whom we care what they want and expect from us, and let’s not be shy about making the deal go in both directions. Even those doing the supervision wonder and worry about how their supervisees are viewing them. Let us strive toward making our expectations clear, and let’s talk about it often and openly.
Saturday, September 26, 2009
Pacing Yourself
Marathon runners know how to pace themselves. They know that if they went all out from the outset of the race they would run out of steam well before the race was done. It is a lesson we all must learn. We must learn how to slow down in order to get the job done well, and to prevent ourselves from burning out along the way.
Slowing down also allows us to see the scenery around us, to take in the beauty and majesty of this magical world in which we live. It allows us to see the sparkle in our children’s eyes, and to catch the nuances that we are likely to miss as we race through our everyday lives.
Those of us who have done this job for a while get a thrill from seeing our children learn to do things and be things that they could not do or be before. We celebrate our children’s accomplishments, and truly take joy in the small roles we have played in their progress. Yet there are times when coming to work does not feel so thrilling or joyful. We begin to forget the reasons we do what we do, we pick up the pace and rush to meet obligations.
When we rush to get through our days we begin to breathe shallowly, and as we breathe shallowly we begin to think shallowly. We do our jobs poorly and sloppily. We live in the future and the past, and each individual moment disappears before we can live in it and feel its power.
Ironically, we rarely get more done by moving faster, or if we do the quality of our work suffers. Remember that we can do better work by recalling the things about our work that brought us here to begin with; the joy of seeing children lead richer lives and making a difference in the world. Remember that we rarely accomplish anything by repeatedly blasting ourselves for past mistakes, and that our past is merely a catalogue of present moments; if we want to create a past that will serve us well the only way to do so is to live meaningfully in the present. Slow down and focus on what is in front of you. Breathe deeply and involve yourself passionately in your work, and reward yourself meaningfully when your work is well done. Maintain your high standards, but refuse to let perfectionism take hold. Be both honest and fair to yourselves. And remain grateful for the gifts you have been given.
Slowing down also allows us to see the scenery around us, to take in the beauty and majesty of this magical world in which we live. It allows us to see the sparkle in our children’s eyes, and to catch the nuances that we are likely to miss as we race through our everyday lives.
Those of us who have done this job for a while get a thrill from seeing our children learn to do things and be things that they could not do or be before. We celebrate our children’s accomplishments, and truly take joy in the small roles we have played in their progress. Yet there are times when coming to work does not feel so thrilling or joyful. We begin to forget the reasons we do what we do, we pick up the pace and rush to meet obligations.
When we rush to get through our days we begin to breathe shallowly, and as we breathe shallowly we begin to think shallowly. We do our jobs poorly and sloppily. We live in the future and the past, and each individual moment disappears before we can live in it and feel its power.
Ironically, we rarely get more done by moving faster, or if we do the quality of our work suffers. Remember that we can do better work by recalling the things about our work that brought us here to begin with; the joy of seeing children lead richer lives and making a difference in the world. Remember that we rarely accomplish anything by repeatedly blasting ourselves for past mistakes, and that our past is merely a catalogue of present moments; if we want to create a past that will serve us well the only way to do so is to live meaningfully in the present. Slow down and focus on what is in front of you. Breathe deeply and involve yourself passionately in your work, and reward yourself meaningfully when your work is well done. Maintain your high standards, but refuse to let perfectionism take hold. Be both honest and fair to yourselves. And remain grateful for the gifts you have been given.
Monday, April 27, 2009
PCFA Speaks
April is now receding into the past. As Autism Awareness Month, it is perhaps one of the busiest months of the year. I have just returned from Queretaro, Mexico, where PCFA alum Teresa Tassinari hosted an extraordinary conference called “Primer Encountro Internacional de Autismo y Desordenes del Desarrollo”, which I'm pretty sure means “First International Conference on Autism and Developmental Disorders”. Teresa was kind enough to invite me to deliver the keynote address, which I titled “Myths, Magic and Reality in the Treatment of Autism.” Also on the program were PCFA supervisors Stefanie Finney and Marta Marquez. Stefanie presented on “Implementation of ABA Programs in California: Methods of Intervention and Results” and Marta presented on “What is Autism and What are its Behaviors?” (Not sure if I translated Marta's title correctly from Spanish.) All of our presentations were very well received by the eager audience, composed of parents, students and professionals.
Earlier in the month I presented at the first autism conference in Armenia, providing a basic overview of the history, theory and techniques of Applied Behavior Analysis, and PCFA supervisor Arpi Arabian also presented on “Theory of Mind and Autism.” Arpi's presentation went extremely well.
In Mexico, one of the presenters in the two-day conference was a past PCFA therapist who went on to work for a school district. It was interesting to hear how many other past therapists were also working for school districts, and to play the “where are they now?” game with a group comprised of both current and past PCFA staff members. It is really interesting to think of how PCFA functioned as the training ground for so many professionals over the years, and how widespread their influence has become.
Earlier in the month I presented at the first autism conference in Armenia, providing a basic overview of the history, theory and techniques of Applied Behavior Analysis, and PCFA supervisor Arpi Arabian also presented on “Theory of Mind and Autism.” Arpi's presentation went extremely well.
In Mexico, one of the presenters in the two-day conference was a past PCFA therapist who went on to work for a school district. It was interesting to hear how many other past therapists were also working for school districts, and to play the “where are they now?” game with a group comprised of both current and past PCFA staff members. It is really interesting to think of how PCFA functioned as the training ground for so many professionals over the years, and how widespread their influence has become.
Sunday, March 8, 2009
Cal-ABA week
So if you are not familiar with Cal-ABA, it is not a western U.S. version of a Swedish pop music group. It is the organization to which many behavior analysts in California belong, and it holds an annual convention which has become quite a big deal. The convention alternates each year between Northern and Southern California, and this year it is being held in Burlingame, a suburb just south of San Francisco. The conference begins on Thursday, March 12, and ends on Sunday the 15th.
PCFA will have quite a presence at the conference this year. We are sending nearly 30 supervisors and senior therapists. Our very own Cara Entz and Sally Torrens will be presenting this year, so if you are going to be there make sure to show up and give them some support. We will also have a booth in the exhibit hall or lobby, where I will be mostly hanging out. So please come visit me to chat. Looking forward to seeing you in the Bay Area!
PCFA will have quite a presence at the conference this year. We are sending nearly 30 supervisors and senior therapists. Our very own Cara Entz and Sally Torrens will be presenting this year, so if you are going to be there make sure to show up and give them some support. We will also have a booth in the exhibit hall or lobby, where I will be mostly hanging out. So please come visit me to chat. Looking forward to seeing you in the Bay Area!
Friday, February 27, 2009
Prozac Nation
Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor, which is a rather fancy way of saying that it works by making more of the neurotransmitter serotonin available in the synapses (the spaces between neurons) in the brain. Given that serotonin levels have been linked to much of what spiritually ails we humans (and mice of course), and that parents of children with autism and all of us in the field are so desperate to find avenues of improving our childrens' lives, it is no wonder that studies are being conducted to investigate the effectiveness of using SSRI's such as Prozac for children with autism.
A study currently being conducted by a specialty pharmaceutical company called Neuropharm Group, which manufactures a new form of fluoxetine, has so far yielded disappointing results. This study investigated the effects of this new form of Paxil on the repetitive behaviors of children with autism. In this double blind study, results have demonstrated that both Paxil and placebo reduced the repetitive behavior of children with autism, and that the differences between the two were not significant.
There are two interesting aspects of this study to me. First, the study was sponsored by the same company that manufactures the medicine, and their conclusions were that it was no more effective than placebo. This conclusion will result in tremendous financial losses for this company, yet they had the integrity to publicize these negative results. While one certainly can't conclude that all drug companies have integrity, it is clear that at least one does. Second, it is always interesting to me to think about the power of a placebo. Simply the belief that an intervention will work will often "cause" the intervention to work. The general effectiveness of placebos begs the classic mind/body question. Does it make any sense at all to assume that the mind is somehow different from the body?
Classic studies done in the 1970's revealed that the neurochemistry of actors who pretended to be depressed or schizophrenic yielded the same metabolites in their urine as patients hospitalized for those conditions for many years. So if we do separate our thoughts from our chemistry, then we must always ask the chicken and egg question. And if our thoughts change our chemistry, and our chemistry changes our thoughts, how should one intervene?
..... Our deepest regrets and prayers are with our Southern California scheduler Linda for her recent loss. Also, we wish Chrisa Sadd a speedy recovery, and a very happy birthday to Elizabeth Fraines.
A study currently being conducted by a specialty pharmaceutical company called Neuropharm Group, which manufactures a new form of fluoxetine, has so far yielded disappointing results. This study investigated the effects of this new form of Paxil on the repetitive behaviors of children with autism. In this double blind study, results have demonstrated that both Paxil and placebo reduced the repetitive behavior of children with autism, and that the differences between the two were not significant.
There are two interesting aspects of this study to me. First, the study was sponsored by the same company that manufactures the medicine, and their conclusions were that it was no more effective than placebo. This conclusion will result in tremendous financial losses for this company, yet they had the integrity to publicize these negative results. While one certainly can't conclude that all drug companies have integrity, it is clear that at least one does. Second, it is always interesting to me to think about the power of a placebo. Simply the belief that an intervention will work will often "cause" the intervention to work. The general effectiveness of placebos begs the classic mind/body question. Does it make any sense at all to assume that the mind is somehow different from the body?
Classic studies done in the 1970's revealed that the neurochemistry of actors who pretended to be depressed or schizophrenic yielded the same metabolites in their urine as patients hospitalized for those conditions for many years. So if we do separate our thoughts from our chemistry, then we must always ask the chicken and egg question. And if our thoughts change our chemistry, and our chemistry changes our thoughts, how should one intervene?
..... Our deepest regrets and prayers are with our Southern California scheduler Linda for her recent loss. Also, we wish Chrisa Sadd a speedy recovery, and a very happy birthday to Elizabeth Fraines.
Monday, February 23, 2009
The Little Things
What is it that we miss most about someone when they're gone? It may or may not be the things we love most about them when they are with us. The things we miss the most are not always the most obvious. They are not always the large things. They are not necessarily the great achievements, the number of books published, the amount of money someone makes, the fancy car they drive. What we miss most are the small things. Sometimes they are the awkward moments, the moments of spontaneity, a tear shed at an unexpected moment, the thoughtful gift, the kind word at just the right time, the odd laugh, the warm and secure embrace in a moment of fear.
In Ben Affleck and Matt Damon's film Good Will Hunting, there is a moment when Will's therapist Sam McGuire talks to Will about McGuire's wife who died of cancer: "My wife used to fart when she was nervous. She had all sorts of wonderful idiosyncracies. She used to fart in her sleep. One night it was so loud, it woke the dog up. She woke up and asked, "Is that you?" I didn't have the heart to tell her. Those are things I miss the most, wonderful things, the little idiosycracies that only I know about. That's what made her my wife."
It is, of course, these little things that make us all who we are. It is those little things we miss the most when we lose something or someone precious to us.
Those of us who devote our life's work to children with deep needs share much in common. One of these is a passion for helping. But we all help in different ways. Let us struggle to celebrate the small differences we discover in each other, the small accomplishments our children make. It is these small accomplishments we will remember in the years ahead. It is the small differences we make in children's lives that our children's parents will remember us for. It is the small acts of devotion and kindness that we will cherish in each other.
In Ben Affleck and Matt Damon's film Good Will Hunting, there is a moment when Will's therapist Sam McGuire talks to Will about McGuire's wife who died of cancer: "My wife used to fart when she was nervous. She had all sorts of wonderful idiosyncracies. She used to fart in her sleep. One night it was so loud, it woke the dog up. She woke up and asked, "Is that you?" I didn't have the heart to tell her. Those are things I miss the most, wonderful things, the little idiosycracies that only I know about. That's what made her my wife."
It is, of course, these little things that make us all who we are. It is those little things we miss the most when we lose something or someone precious to us.
Those of us who devote our life's work to children with deep needs share much in common. One of these is a passion for helping. But we all help in different ways. Let us struggle to celebrate the small differences we discover in each other, the small accomplishments our children make. It is these small accomplishments we will remember in the years ahead. It is the small differences we make in children's lives that our children's parents will remember us for. It is the small acts of devotion and kindness that we will cherish in each other.
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