ABA Quality of Life (Gambrill, 2013)

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Invited Article
Birds of a Feather: Applied Behavior
Analysis and Quality of Life
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
Baer lecture at this conference. The greatest gift of this invita-
tion is the opportunity to luxuriate in the clarity of Don’s think-
ing, his openness to ideas and total presence. No one has
described Don better than his wife, Dr. Elsie Pinkston, Profes-
sor Emeritus, School of Social Service Administration, Univer-
sity of Chicago, through whom I met Don. Following Don’s
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
offered a poem entitled ‘‘Is It Fair?’’ Her last lines in this poem
capture Don’s essence
There really are few unknown things to tell.
He was the man that he appeared to be;
What you saw was what you got,
And there was a lot to see.
Striking to me about Don Baer was his total presence when
you were with him, whether in person or as a reader of his
prose, and his intense curiosity about life, especially behavior
and how to change it. Many have remarked on the clarity of
Don’s prose. Indeed, in remembrances to Don, his skill with
words are highlighted; he had a sign on his office door—
‘‘Wordsmith.’’ This clarity enabled ideas about how to explore
the controlling conditions of behaviors in experiment after
experiment, with students and colleagues over his long produc-
tive career. Don was a pristine wordsmith, one who avoided all
kinds of distracting, misleading, confusing prose. He was
exceptionally clear analytically, modeling one of the key
characteristics of applied behavior analysis (ABA). Together
with his colleagues Montrose Wolfe and Todd Risley, Don
Baer wrote ‘‘Some current dimensions of applied behavior
analysis’’ published in 1968 and a follow-up article in 1987.
Their 1987 article ‘‘Some still-current dimensions of applied
behavior analysis’’ is both a description of what ABA is and
a discussion of its possible future.
ABA
ABA is a scientific approach to the study of behavior paying
careful attention to the social validity of concerns addressed
and related outcomes (Wolf, 1978). This applies to clients as
well as to their significant others, those who influence clients
and who may be affected by interventions. Key characteristics
of ABA include attention to context (environmental) influences
and constructing repertoires building on those clients and sig-
nificant others already possess. ABA is based on the findings
from the experimental analysis of behavior—a scientific
approach to behavior in which we try to identify the variables
that influence behaviors of concern (conduct a descriptive anal-
ysis) and then vary these to determine if we are correct in our
guesses (conduct a functional analysis). In this way, we can
1 University of California, Berkeley, CA, USA
Corresponding Author:
Eileen Gambrill, School of Social Welfare, Haviland Hall, University of
California at Berkeley, Berkeley, CA 94720, USA.
Email: gambrill@berkeley.edu
Research on Social Work Practice
23(2) 121-140
ª The Author(s) 2012
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find out which of our guesses are wrong. Consider the assump-
tion that sensory integration therapy (brushing and joint com-
pression) is effective in decreasing aggressive behavior of a
nonverbal 8-year-old boy with autism. The occupational
therapist at the child’s school recommended this intervention.
Investigation within a single-case design showed that this inter-
vention actually increased hitting episodes, a negative outcome
(Kay & Vyse, 2005). Applications range from the simple (e.g.,
Allday, Bush, Ticknor, &Walker, 2011; Singer-Dudek, Oblak,
& Greer, 2011) to the complex (e.g., Sailor, Dunlap, Sugai, &
Horner, 2009).
Applied
In their article ‘‘Some still-current dimensions of applied beha-
vior analysis,’’ Baer, Wolf, and Risely (1987) describe applied
as referring to ‘‘at least behaviors of a person called subject or
client that trouble that person; but more often, they are also
behaviors of people other than the one called subject or client’’
(p. 314). They suggested that ‘‘Social problems are those beha-
viors of the subject or client that result in counterreaction,
sometimes by the client, but more often by nonclients, suffi-
cient to generate something called a solution, or at least a pro-
gram’’ (p. 314). Thus, ‘‘social problems are essentially the
behaviors of displaying or explaining problems—one’s own
or someone else’s’’ (p. 314). Such displays may be very indi-
vidual (a personal problem) or very broad (referred to as a
social problem). Behavior analysts have contributed to the
understanding of cultural and behavioral change, including
organizational change (e.g., Biglan, 1995, 2009; Daniels,
2000; Mattaini, 2003). Malott and Glenn (2006) suggest that
a cultural problem occurs when a ‘‘condition causing dissatis-
faction or threat is the aggregate product of the behavior of
many people.’’
Behavioral is a second key dimension of ABA. Measure-
ment of behavior involves ‘‘the direct observation and record-
ing of a subject’s target behaviors by an observer under the
stimulus control of a written behavior code’’ (p. 316). Baer and
his coauthors (1987) note the enormous interest in behavioral
theory and technology.
One mark of the success of applied behavior analysis in the last
two decades is that its practitioners, researchers, and theorists
have encountered so many invitations to become something
other than behavioral, in the form of becoming something
‘‘more’’ than behavioral. In particular, their occasional main-
streaming with behavior therapy, education, developmental
psychology, psycholinguistics and sociobiology has given them
the chance to entertain constructs of attention, intelligence, dis-
abilities, spontaneity, readiness, critical period, innate releasers,
storage and retrieval mechanisms, schemata and the like. (p. 315)
They suggest that ‘‘the most fruitful task, however, is to recog-
nize that each of those labels (and many others like them) often
represents some behavioral reality not yet analyzed as such’’
(p. 315). Behavioral methods continue to be applied to many
different areas including behavioral medicine, organizational
change, school wide programs, behavioral sports, and treat-
ment of depression. Baer and his colleagues (1987) suggest that
‘‘Perhaps the clearest measure of our discipline’s effectiveness
is the increased number of ineffective applications that we have
tried in recent years’’ (p. 323). As they note, ‘‘failures teach’’
(p. 325).
Analyticcomputerized cognitive behavior therapy is used
in Scotland (NHS 24). Maybe all that is needed to perk up
some of the dejected is to receive a text message at unpre-
dictable times: ‘‘How r u?’’ But for how many?
2. Situations in which a great deal could be done, given a
well-trained behavior analyst. What are these situations?
As Haynes, Leisen, and Blaine (1997) suggest, ‘‘a func-
tional analysis is likely to be more cost-effective for some
behavior problems than for others’’ (p. 346). How flexible
can we be and attain similar outcomes? Greater attention
has been given to system-wide changes needed to establish
and maintain behaviors that contribute to quality of life
(e.g., Freeman et al., 2001; Sailor et al., 2009). Still there
is a long way to go. For example; although coaching and
feedback are vital for maintaining effective teacher beha-
viors, in most schools these valuable interventions are not
used (Keyworth, 2012).
Create a Functional Typology Revealing the Complexity of
Environmental Circumstances Related to Concerns
Skinner (1974) suggested that ‘‘A science of behavior is espe-
cially vulnerable to the charge of simplification because it is
hard to believe that a fairly simple principle can have vast con-
sequences in our lives’’ (p. 231). The writing of many behavior-
ists including Don Baer and B. F. Skinner is very clear. Key
points can be all too quickly read and dismissed as irrelevant,
such as the statement that feelings are clues to contingencies.
To dispel misrepresentations that ABA is ‘‘simple’’ or ‘‘simple
minded,’’ we must do a better job of revealing the complexity
of application (e.g., Kanter, Cautilli, Busch, & Baruch, 2005;
Layng, 2009). The seductive allure of pathology and of ment-
alism may be countered by repeated illustrations of the varied
kinds of environmental contingencies that influence behavior
including creation of very unusual repertoires (behaviors that
appear bizarre) and the difficulty in identifying influential con-
tingencies (e.g., Goldiamond, 1974, 1984).
Appeal to thoughts and feelings are incomplete accounts
which, when viewed as complete, hinder change. Somehow,
we must show this over and over by memorable accounts of lost
opportunities to help clients by accepting incomplete accounts.
Only by a contextual analysis of problems is the heroic nature
of clients revealed. Behaviors that appear bizarre are usually
creative (but costly) solutions to life’s challenges (Goldia-
mond, 1974). Only in light of scant opportunities for positive
reinforcement for adaptive behaviors may the occurrence of
troubling or troubled repertoires be understood. Examples
could be arranged under varying kinds of controlling condi-
tions including positive reinforcement, negative reinforcement,
punishment, mixes of all three, scheduling effects, contrast
effects, influence by equivalence relations, potentiating effects,
stimulus control, and so on (e.g., Baer, 1982, Waltz & Follette,
132 Research on Social Work Practice 23(2)
2009). We should describe memorable examples for each kind
of circumstance to encourage understanding. Examples include
1. adventitious reinforcement;
2. linking a positive reinforcer with an aversive event (e.g.,
only if I get a shock will I get food—not starve). Only if
I appear to have an immobilizing anxiety or obsession will
I get attention from family members or famous therapists.
3. Only if I perform a certain response within a set time will I
avoid a bad event (e.g., as in Sidman avoidance schedule).
4. variable ratio schedules and their effects (e.g., as in
gambling).
5. low levels of reinforcement for any behavior.
For each, we should provide vivid case examples of topical,
linear, and systemic analyses. In a topical analysis, there is a
direct focus on a disturbing behavior (DB), for example, hallu-
cinations or talking out of turn in class. Topical analyses may
be linear or nonlinear. In linear analyses (‘‘eliminative’’ or
‘‘pathological’’ approaches), there is a direct focus on the DB
and eliminative methods are used such as extinction, punish-
ment, and/or response cost to decrease the DB (Andronis,
Layng, & Johnson, 1997). The effects on the DB of conse-
quences attached to available alternative repertoires (AABs)
are ignored in a linear analysis (Goldiamond, 1984, p. 535). Let
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
an eliminative method focused on the DB. Topical nonlinear
analyses also focus on the DB such as yelling out in class, but
a desired alternative such as raising his hand or waiting to be
called on is identified and reinforced; the focus is still on the
DB, but a constructional approach is used.
A systemic behavior analysis broadens assessment to
include identification of AABs that can be used to alter the fre-
quency of DBs. Current available repertoires (behaviors the cli-
ent already has, such as social skills) are transferred to new
situations. Emotions and thoughts can be used to identify
related contingencies. Both this kind of analysis and a non-
linear topical analysis are constructional approaches that
require consideration of what is not occurring, such as for
example positive social contacts. Both offer guidelines for
decreasing the DB by improving the cost–benefit ratio of
AABs. Target behaviors (those focused on to change) are
selected based on a review of the costs and benefits associated
with DBs and AABs. Target behaviors should ‘‘depotentiate’’
(decrease the likelihood of) costly DBs; they should be less
costly than the DB and provide more benefits to both the client
and significant others. A target behavior could be on-task beha-
vior encouraged by providing instructional tasks that engage
the student’s attention. Notice that in plans based on a systema-
tic analysis, the conditions that ‘‘potentiate’’ a reinforcer, such
as escape from boring or overchallenging material, are
removed; there is no need to escape because the instructional
material now engages the students. A constructional analysis
requires information about AABs (Goldiamond, 1974, 1984;
Risley, 1996). It may require observation in real-life settings.
Examples should include those that require simple interven-
tions that are effective (e.g., use of stimulus control—creation
of a ‘‘sulking stool’’ to decrease sulking behavior (Goldia-
mond, 1965) as well as those that require complex interven-
tions (e.g., Goldiamond’s [1984] systemic analysis and
intervention regarding a woman who engaged in ‘‘binge
eating’’). Examples will illustrate that behaviors that appear
irrational are shaped by environmental contingencies and are
maintained by current reinforcement patterns. No matter how
bizarre or dysfunctional a disturbing behavior may seem (the
DB), when the history and current environmental context are
explored, including AABs, and the costs and benefits related
to these different behaviors are compared, we can see that DBs
have been selected by the social environment (Layng & Andro-
nis, 1984). For example, only by acting ‘‘crazy’’ may a person
gain access to resources provided only to those who act
‘‘crazy.’’ This kind of analysis that attends to function (process)
rather than form (e.g., DSM, 2000), normalizes deviant beha-
viors by making them understandable in relation to unusual
environments; behavior always ‘‘makes sense.’’ The stronger
the belief in ‘‘mental illness’’ (brain disease as the cause of odd
behavior), the greater the resistance to this normalizing view
may be. But the key question should be: ‘‘Which view is more
likely to enhance quality of life for clients and their significant
others?’’
Help All Involved Parties to Detect and Avoid Influence by
Propaganda
Getting the straight scoop about what is true and what is not is
not an easy task. The essence of propaganda (encouraging
beliefs and actions with theleast thought possible, Ellul,
1965) is to distort or hide realities. For example, mentalistic
explanations hide controlling conditions (Skinner, 1971).
Often, ignorance is intentionally promoted. Hucksters take
advantage of hope, fear, and suffering to lure us to buy services
and products that not only may be worthless, but may harm us.
Pharmaceutical companies hire public relations firms (or use
their own) to plan how to market a drug. For example,
Glaxo-SmithKline hired the public relations firm Cohn and
Wolfe to lay the groundwork for the introduction of Paxil
which became a blockbuster drug (Moynihan & Cassels,
2005). First on the plan was to create and position the diagnosis
of ‘‘social anxiety disorder’’ (formerly known by the more
benign term as social phobia) as of great prevalence and
concern. Fines against pharmaceutical companies for illegal
promotion of products, ‘‘sham advisory boards,’’ and mislead-
ing journal articles, are in the billions as illustrated by the
$3 billion fine against GlaxoSmithKline for unlawful practices
(Roehr, 2012). Professionals are supposed to help; they want to
help. This alone may result in use of interventions that are
harmful or unnecessary. The first conference on avoidable use
of unnecessary interventions was held in April 2012.
We should help both clients and professionals to detect
misleading claims which contribute to avoidable suffering.
These include bogus claims of knowledge (and ignorance),
Gambrill 133
about risks, effectiveness of interventions, prevention, and
accuracy of diagnostic instruments (Gambrill, 2012a). Accu-
rate understanding of the scientific method is needed to distin-
guish between helpful and trivializing or bogus uses of this
approach. Bogus uses include reliance on scientific ideology
to reaffirm and maintain current definitions or problems and
service delivery systems that may, in reality, hinder rather than
enhance the quality of life for clients. Classification of clients
into psychiatric categories lends an aura of scientific credibility
to this practice, whether or not there is any evidence that this is
warranted or that it is helpful to clients in meeting their needs.
There has been a rush to premature dubbing of interventions as
‘‘evidence-based’’ which do not warrant this term (e.g., see
Gorman & Huber, 2009).
We should help all involved parties to become aware of the
flawed nature of peer review and related consequences includ-
ing wasting money on ineffective programs. Ioannidis (2005)
argues that most biomedical research findings are false (see
also Ioannidis, 2008). Seventy percent of cancer studies cannot
be replicated (Begley & Ellis, 2012). Retractionwatch.org posts
retractions of research reports because of misconduct including
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-
ing for years to discuss and address problems of peer review.
Being on the lookout for propaganda in the professional litera-
ture is especially important since our guard may be down, per-
haps because a journal uses peer review; readers may not be
aware of problems with peer review. When people discover
they have been fooled they do not like this, especially when
being fooled has been costly in terms of money or other kinds
of harm, including lost opportunities to help clients. So we
should devote great attention to revealing harming in the name
of helping as a result of propaganda and other kinds of mislead-
ing activities including misdirected education. We should blow
the whistle on endless marker variable research in place of pro-
gressing on to experimental methods.
Use Our Conceptual Analysis and Related Technology to
Enhance Use of Effective Methods
If behavior always makes sense, rather than complain about
countervailing contingencies, we should take advantage of con-
ceptual knowledge and related technology to understand and
alter countervailing contingencies. Obstacles and failures pro-
vide a guide for planning. Baer and his coauthors (1987) sug-
gest that the decades between 1967 and 1987 ‘‘have not
yielded a better public analysis of effective problem display
and explanation . . . At best, they have shown us that we need
analyses of (a) displaying and explaining problems so as to gain
effective use of the media, (b) controlling the behavior of those
other people who can function as decision makers’ constituen-
cies (i.e., lobbying), (c) having or being able to recruit cam-
paign support, and (d) recognizing events called crises as the
setting events when those repertoires will be most effective . . .
those analyses are necessary to understand fully what we most
often mean by applied. We mean every form of countercontrol
typically under the stimulus control of problem displays and
explanations’’ (p. 315).
As suggested earlier, many parties hide what is done to what
effect at what cost and related controlling contingencies (e.g.,
who makes money by providing ineffective or harmful services
(products) to clients/students). We should identify these parties
and use a contingency analysis to plan how to alter programs so
that more clients and students receive more effective programs.
This will be a complex analysis at many levels including pro-
fessional education, institutional settings, and managed care
policies. This descriptive analysis will suggest entry points for
change. In the face of overwhelming countercontrol by those
involved, we must look elsewhere to encourage change such
as exposure of the harmful effects and waste of continuing to
provide ineffective education and clinical services and related
deceit, greed, and indifference. (See section on revealing
avoidable suffering.) A programmatic approach (as illustrated
in some school and community-wide positive behavior support
(PBS) systems and their dissemination) provides a guide (e.g.,
Sailor et al., 2009; See also Biglan, 1995).
Use More User-Friendly Language
Baer and his colleagues (1987) emphasize the role of language
as an impediment to the wide dissemination of behavioral
methods. ‘‘The past 20 years have shown us again and again
that our audiences respond very negatively to our systematic
explanations of our programs and their underlying assump-
tions, yet very positively to the total spectacle of our pro-
grams—their procedures and their results—as long as they
are left ‘unexplained’ by us’’ (pp. 315–316). They suggest lan-
guage options to maximize our effectiveness (See also Bailey,
1991; Lindsley, 1991). Clear writing and engaging, detailed
descriptions of the use of effective methods to resolve real-
life concerns will encourage dissemination (e.g., Pinkston &
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.
Draw on Research Regarding Dissemination
Many fields, including public policy and social psychology
(e.g., research on persuasion and conformity) and the experi-
mental analysis of behavior, contribute to exploring the ques-
tion: ‘‘Under what circumstances does behavior change?’’
including. Gaps between knowledge available and what is used
to enhance quality of life has been of key interest in health care
(e.g., Kitson & Straus, 2009). For example, the time between
symptoms of a heart attack and arrival at the emergency room
(ER) is important. Thus, we can ask what percentage of patients
arrive at the ER within a certain time. If this is not optimal
(which it is not), we can then identify controlling conditions
of timely arrival. We can use this information to arrange for
a higher percentage of timely arrivals. Consider also what hap-
pens when patients arrive at the ER. If timely use of a certain
134 Research on Social Work Practice 23(2)
treatment improves chances of living,we can ask: What per-
centage of patients at what different hospitals receive this treat-
ment in a timely manner? We can then identify the controlling
conditions for disseminating and maintaining ‘‘best practices.’’
If half of all doctors are below average, what is the case for
social workers (Poloniecki, 1998)? If half of patients in inten-
sive care receive suboptimal care, what would we find in social
work agencies (Kmietowicz, 2005)? There is an extensive liter-
ature describing gaps in use of knowledge and efforts to make
use of available knowledge (e.g., Straus, Tetroe, & Graham,
2009). This literature describes obstacles and suggests opportu-
nities. Obstacles include those discussed earlier in this article.
Organizational cultures and climates may discourage
change including a preference for authority-based decision
making—what an administrator dictates. Practitioners may
lack access to important resources such as databases needed
to make informed decisions (e.g., Gray, 2001; Palinkas & Soy-
dan, 2012). We should draw on related literature to discover
options (See also Atkins, Siegel, & Slutsky, 2005; Bambara,
Goh, Kern, & Caske, 2012). Under what circumstances will
behavioral accounts replace mentalistic approaches that are not
effective? We can seek information about why ABA has been
successful in some contexts and not in others. For example, use
of ABA with children with developmental disabilities has been
encouraged by lobbying efforts of their parents. Parents discov-
ered important knowledge and advocated for its use. An educa-
tional approach for communicating with policy makers is
advocated by Bogenschneider and Corbett (2010) in which the
aim is to inform policy makers rather than to influence them,
including informing involved parties about both what is
‘‘known’’ and what is not and separating fact and opinion. Fair-
ness of presentation is emphasized.
Involve Consumers/Clients
Engaging consumers in closing knowledge gaps is a key route
to taking advantage of ABA to enhance quality of life. Use of
ABA has increased in some areas due to advocacy efforts of
clients and significant others as suggested earlier. There is a
rich literature in evidence-informed practice describing ways
to involve consumers (e.g., Coulter & Collins, 2011). We can
refer clients to Cochraneconsumers.org and include clients in
conference presentations. Clients’ views of the value of out-
come differ from clinicians’, thus it is vital to gather these
views (Basch et al., 2009).
Combine Efforts: Birds of a Feather Flock Together
Fragmentation of efforts across many different associations
may dilute effective dissemination (e.g., see Critchfield,
2011). Becoming insular is always a danger in terms of lost
opportunities to enhance the quality of clients’ lives. In addi-
tion to separate associations and other kinds of groups, efforts
should be combined in effective dissemination (e.g., see PBS—
Kansas Logic model, Freeman et al., 2010).
Create and Maintain an Engaging Website Showcasing a
Science of Behavior
Compare the current website of the Association of Applied
Behavior Analysis International with what could be on this site
in terms of encouraging use of effective methods. Possible
(currently missing) components include the following:
A ‘‘Have You Been Fooled/Bamboozled?’’ Section. The
goal of this section would be to enhance people’s skills
in detecting common ways in which they are fooled and
to enhance skills, including contingency analysis skills,
to decrease their odds of being ‘‘taken-in.’’
A ‘‘What’s Missing?’’ Section. Propaganda in the helping
professions appeals to oversimplified views of life experi-
ences; ‘‘It’s in the brain’’; ‘‘It’s in the genes’’; ‘‘It’s
caused by our thoughts.’’ Asking ‘‘What’s missing?’’ is
valuable in avoiding misleading oversimplifications. A
‘‘What’s missing? ’’ section could include examples of
incomplete assessments. The more we can make our
examples like a detective story, the more likely people are
to engage with the material. Detective stories present a
problem—who did it? We could ask, ‘‘What is wrong
with this picture?’’ Failure to recognize environmental
influences is a key reason distortions and misrepresenta-
tions of ABA and radical behaviorism are so common.
If such influences were more vivid, their role would be
more difficult to disregard, including contingencies
related to behaviors that could successfully compete with
those complained of. We could include a weekly example
challenging readers to test their skills in functional anal-
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
to enhance behavioral literacy (e.g., see Carr & Fox,
2009). This would include links to sources illustrating
effective applications of behavioral principles such as
‘‘It’s Me or the Dog,’’ a popular TV show in which Vic-
toria Stillwell illustrates the application of basic beha-
vioral principles to pet behavior problems, which, as
would be expected in a behavioral approach, are linked
to human behaviors. She focuses on the use of positive
reinforcement, stimulus control, and shaping to encour-
age hoped-for changes.
A ‘‘Neglected Successful Programs’’ Section highlighting
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-
man & Mackenzie, 2010). We could describe classic studies
which illustrate underused effective interventions. To how
many communities has the Juniper Gardens Children’s
Project been disseminated (e.g., Greenwood et al., 1992)?
A ‘‘Valuable Resources’’ Section linking readers to other
valuable websites such as PharmedOut.org, DUETS,
healthyskepticism.org, fallacyfiles.org, and www.
cochraneconsumer.org
Gambrill 135
A ‘‘Self-Experiment’’ Section describing valuable self-
experiments others have conducted including past uses
of self-management methods (e.g., see Roberts, 2004; Sil-
verman, 1986).
A ‘‘Useful Apps and Games’’ Section. Games could depict
different kinds of contingency analysis challenges and
possible approaches and provide repeated opportunities
to model valuable questions such as ‘‘What’s missing?’’
‘‘Who says so?’’ ‘‘Is it true?’’ Apps designed to enhance
observation and propaganda detection skills can be noted.
Comparison of a computerized cognitive behavioral self-
help intervention using a game format with intervention
as usual, found the former to be more effective in
decreased depression, anxiety, and hopelessness among
adolescents (Merry et al., 2012; see also www.
healthit.gov).
An ‘‘Opportunities to Meet Birds of a Feather’’ Section (e.g.,
listing of conferences and training opportunities, special
interests groups).
A ‘‘What’s new?’’ Section alerting viewers to new books/
websites such as Addiction: A disorder of choice by
Heyman (2009).
Conclusion
Disseminating knowledge that contributes to enhancing quality
of life is of interest in all helping professions. The history of
medicine is replete with lost opportunities to avoid harm and
to help people. This is also true in the interpersonal helping
fields of psychology, psychiatry, social work, and counseling.
The history of ABA is filled with creative applications of basic
behavioral principles that have helped people to enhance the
quality of their lives. Let us make these histories more visible
in terms of gaps between what was done and what could have
been done. How often do we hear ‘‘If I had only known.’’ Baer
et al. (1987) suggest that ‘‘effectiveness for the future will
probably be built on system-wide interventions and high-
quality failures, as we continue to bring theory to the point of
designs that solve problems’’ (p. 325)—a very Popperian
(1994) view of the growth of knowledge. They suggestthat the
most important remedy of all, ‘‘will be to establish the proper
context in which to respond to failures’’ (p. 324). They also
raise the question as to whether technological failure is the
same as theoretical failure. ‘‘We should expect a long period
of difficult, expensive, repetitive, and sometimes ineffective
research into these applications, and we should enter that
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
reaction-to-failure work behind us, it seems clear that we can
do it’’ (p. 325).
Let us reveal situations in which use of ABA would mini-
mize lost opportunities to help clients. Environmental varia-
tions are increasingly recognized as vital even in gene
expression as can be seen in the burgeoning field of epigenetics
(see also Plomin, 2011). Let us help all involved parties to see
past the clutter of hundreds of theories/remedies. One life
choice is whether to see misery in people’s lives and how much
or to turn away. All great religions address this issue and urge
us to take a stand against inhumanity and avoidable suffering.
But there is many a slip between the call and the action pro-
pelled in part by the profit and the prophet motives (Jarvis,
1990). The eyes may grow weary of seeing plights that appear
unsolvable. However, professionals are obligated by their
codes of ethics to see and to take action to decrease avoidable
suffering. Only if we expose waste and avoidable miseries,
including those due to neglect of methods that can help people
to increase their quality of life, are we likely to make more
headway in closing gaps. We can draw on a science of behavior
to discover and alter relevant conditions. Some say that beha-
viorists are optimists. Here is a view by Don
Some of us have ignored both the thesis that all persons are
educable and the thesis that some persons are ineducable, and
instead have experimented with ways to teach some previously
unteachable people. Over a few centuries, those experiments
have steadily reduced the size of the apparently ineducable
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-
diction? Why not pursue it to see if there comes a day when
there is such a small class of apparently ineducable persons left
that it consists of one elderly person who is put forward as
ineducable. If that day comes, it will be a very nice day. And
the next day will be even better. (D. M. Baer, personal commu-
nication, February 15, 2002 in Heward, 2013, p. 16).
We can take advantage of a science of behavior and related val-
ues to design and disseminate programs that help people to
enhance the quality of their lives. Don Baer likened behavior
analysis to a tree with nodes some of which form a branch and
some of which flourish. Let us nourish these nodes in a user-
friendly manner informed by a science of behavior.
Author’s Notes
This article was presented as the inaugural Don Baer Lecture at the
annual conference of the Association for Behavior Analysis Interna-
tional, on May 26, 2012, Seattle, WA. This paper was invited and
accepted at the discretion of the Editor.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author disclosed receipt of the following financial support for the
research, authorship, and/or publication of this article: Hutto Patterson
Charitable Foundation.
Note
1. Dr. Pinkston, a superb scholar and delightful human being, died a
few days after this lecture was given.
136 Research on Social Work Practice 23(2)
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> setpagedeviceand Conceptual
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
the much more frequent behaviors that we suppose are precur-
sors to behaviors of interest’’ (p. 317). (See also Goldiamond,
1974, 1984.)
A nonlinear approach involves analysis of (a) the contingency
of which the target behavior is a member (the direct or linear
relations); (b) alternative sets, or matrices, of consequential
contingencies, of which the target behavior and currently avail-
able alternative patterns are members; and (c) the contingencies
or relations that can potentiate the matrices (the nonlinear rela-
tions). This analysis is applied to gain an understanding of the
patterns of observed learner behavior, which occur as a result of
the interaction of these matrices. (Twyman, Layng, Stike-
leather, & Hobbins, 2005, p. 62)
Something may work even though the analysis is faulty (Mor-
ris, 1980). Many practices in medicine work but we do not
know why they work; there is a failure of analysis but not a fail-
ure of effects. ‘‘Applied behavior analysis is more often consid-
ered an analytic discipline only when it demonstrates
convincingly how to make specified behavior changes and
when its behavior-change methods make systematic, concep-
tual sense’’ (p. 318). Baer (1991) suggested that ‘‘radical beha-
viorism recommends reserving merely conceptual control only
for those behaviors not amenable to experimental control’’ (pp.
430–431).
Technological
The technological aspect of ABA refers to the fact that it can be
replicated and effects consistently found. Baer and his col-
leagues (1987) note the need for flexibility to consider unique
individual differences in preferences for certain procedures.
Capable of Appropriate Generalized Outcomes
Generalization over individuals, settings, and time (mainte-
nance) is of key interest. It is often easy to get people to change
their behavior initially such as altering eating patterns and exer-
cising; maintaining these changes is another matter. Do desired
changes occur in other settings? Do changes influence other
behaviors, including those tangentially related to training set-
tings as when learning a problem-solving skill? In ABA, plan-
ning for the generalization and maintenance of behaviors of
122 Research on Social Work Practice 23(2)
value to clients and their significant others is a key component
of intervention. Attention to generalization and maintenance is
indeed one of the great contributions of ABA (e.g., see Gianou-
mis & Sturmey, 2012). Many programs have a ‘‘train and hope
approach’’; they train someone and hope it generalizes or is
maintained over time. Baer and his colleagues (1987) also dis-
cuss generalization in relation to ABA itself.
Effectiveness
Social validity is of great concern. Do the consumers of an
intervention like its goals, targets, effects, procedures, and per-
sonnel? Wolf (1978) suggested that social validity applies to
(1) the significance of behavioral goals, (2) the appropriateness
of behavioral procedures, and (3) the importance of behavioral
effects. Goals, procedures, and effects should be carefully vali-
dated in terms of their acceptability to clients and significant
others. Without attention to social validity of this kind, pro-
grams that can improve quality of life may not be implemented
or disseminated. Scholars in the area of ABA have contributed
to a valuable literature regarding acceptability of goals, proce-
dures, and their effects. Use of social-validity measures aids in
minimizing rejection of an intervention. ‘‘Giving consumers
any opportunity to express complaints and discontents that oth-
erwise would go unnoticed may save at least some programs
from fatal backlashes, at least if the offended consumer is
moved enough by simply the existence of the otherwise inade-
quate social-validity assessment form to write in its margins or
talk to the appliers’’ (Baer, Wolf, & Risley, 1987, p. 323). (See
also Baer, 2004.) As Baer et al. (1987) note, ‘‘the hallmark of
effectiveness may be subtle: sometimes, it seems to be simply
the degree to which the target behavior has been changed;
much more often, it is the degree to which something other than
the target behavior has been changed and that something other
almost invariably is someone’s countercontrol against the orig-
inal behavior’’ (p. 322). ‘‘Almost every successful study of
behavior change ought to routinely present two outcomes—a
measure of the changed target behaviors, of course, and a mea-
sure of the problem displays and explanations that have stopped
or diminished in consequence. Yet very few studies do that’’ (p.
322). They suggest that even though a program may not solve a
problem, it may nevertheless be valuable because it may ‘‘solve
the sometimes more aversive problem of doing nothing about
that problem’’ (p. 314) or may solve an important related prob-
lem. For example, an application may allow the client or coun-
teracting nonclients to discuss the problem. Indeed, they
suggest that there may be no such thing as a totally ineffective
program. Thus, even though problems are not solved, interven-
tions may have some social validity. Could this be why many
‘‘ineffective’’ programs exist?
Effective but Underused
Thousands of studies show that people’s lives can be
improved—can be more interesting, more independent, more
cooperative, and inclusive—by drawing on basic behavioral
principles and related theory. Dissemination and diffusion of
valuable programs are of concern in all areas including ABA
(e.g., Fixsen, Blase, Naoom, & Wallace, 2009; Paine & Bel-
lamy, 1982). Literature in ABA describes creative applications
of findings from the experimental science of behavior includ-
ing building on alternative repertoires to decrease concerns
such as hallucinations and binge eating (Budd & Stokes,
2003; Goldiamond, 1984; Layng, 2009). If a child cannot
speak, develop a picture book that illustrates different kinds
of reinforcers and the child can point to them. If older people
fall asleep during a movie and then awake when the movie is
half over and are thus uninterested, set up a system whereby
if a button is not pressed every few minutes, the movie stops
so that if the person falls asleep, when they awake they will
only have missed a few minutes and retain their interest in
‘‘what happens next’’ (Lindsley, 1964). If conversation is lack-
ing around a table in a retirement home, serve food family style
rather than on individual plates to increase conversation. (See
also McClannahan & Risley, 1975.) If teachers are unwilling
to change their behavior in order to be more positive with chil-
dren in their classroom, teach children how to alter the behavior
of teachers (Graubard, Rosenberg, & Miller, 1971). If learning
is boring, make it game-like (e.g., see Donaldson, Vollmer,
Krous, Downs, & Berard, 2011). The APA Handbook of Beha-
vior Analysis (Madden, 2012) describes applications in envi-
ronmental health, treatment of autism, attention-deficit/
hyperactivity disorder (ADHD), teaching, substance abuse,
industrial problems and business, and sleep problems. Beha-
vioral principles are drawn on to address self-injurious beha-
vior, behavior related to a wide range of health concerns
(e.g., smoking, weight, and drinking), parent–child interaction,
and a range of behaviors in educational settings. They are cen-
tral in working with children and children and adults with
developmental disabilities, in dialectical behavior therapy
(Linehan, 1993) and acceptance and commitment therapy
(Hayes, Strosahl, & Wilson, 2012). They are used to improve
conditions in organizations and communities (e.g., see Free-
man et al., 2010).
However, ABA and related theory often remain underused
or unused in areas in which they could minimizeavoidable mis-
eries and increase quality of life as many have noted (e.g., Mal-
ott, 1996; Morris, 1985; Thyer, 2005). Consider this quote from
Don Baer in 2002:
I note that behavior analysis and applied behavior analysis have
been very small, heavily criticized, and despised disciplines;
I expect that will continue, largely because proof-dependent
natural-science views of human behavior are both threatening
to their competitors and also very poor show business. I expect
that the powerful techniques of applied behavior analysis
will always be quickly stolen from their context and their
terminology, made mentalistic, psychodynamic, or quasineuro-
logical, and used widely by practitioners who credit their effec-
tiveness to cognition, inner motivation, or neurology. I predict
that effectiveness will always be less in their hands than it
would be in the hands of proof-dependent functional analysts,
Gambrill 123
but because the techniques were developed in functionally
analytic, proof-dependent hands, they will maintain some
effectiveness even in clumsy, nonanalytic hands. (Baer quoted
in Wesolowski, 2002, p. 144)
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
(2005) noted that behavioral social work is misprized, mis-
read, and misconstrued. Most texts in social work do not
include terms such as ‘‘behavior analysis’’ or ‘‘applied beha-
vior analysis’’ (let alone radical behaviorism). In most books
on theory in social work, there is no mention of radical
behaviorism or ABA. In Social Work Treatment: Interlocking
Theoretical Approaches (Turner, 2011), behavioral theory is
included as one of 38 entries, all given equal space despite
unequal evidentiary status. It is almost as if related words are
taboo or are a stigmata.
When not ignored, ABA and radical behaviorism are often
misrepresented (Thyer, 2005; Todd & Morris, 1983). Just
recently at a conference on Science and Society at USC held
in May 2011, one of the speakers said: ‘‘Some like behaviorists,
do not acknowledge the importance or ‘reality’ of an internal
mental life’’ (Longhofer & Floersch, 2011). This incorrect
statement could have been avoided by reading any number of
readily available original sources (e.g., Skinner, 1974). And,
there is ‘‘pilfering,’’ which may be good (help clients) or bad
(deprive them of greater gains by more systematic use of beha-
vioral theory and related technology). As Don Baer suggested,
‘‘powerful techniques of applied behavior analysis will always
be quickly stolen from their context and terminology’’ (Baer,
quoted in Wesolowski, 2002, p. 144). An example in social
work is the renaming of scores of behavioral techniques as
‘‘task-centered practice,’’ hiding their origins (Gambrill,
1994). Approaches such as motivational interviewing (Christo-
pher & Dougher, 2009) incorporate behavioral strategies as do
successful parent training programs which cite social learning
theory as their guide (Triple P Parenting Program and Incred-
ible Years Program; e.g., see de Graaff, Speetiens, Smit, de
Wolff, & Taveccio, 2008). Non-take-up of effective interven-
tions is of concern in all professions and is a common problem
(Straus, Tetroe, & Graham, 2009) encouraging the creation of
the process and philosophy of evidence-based practice and pol-
icy (Gambrill, 2006).
Why is behavioral analysis and related theory often ignored
or misrepresented? Is not taking advantage of effective inter-
ventions a kind of mistake? Is it an oversight? Is it hampered
by interfering beliefs, problem-solving styles, and competing
contingencies? What can we do to increase the use of proce-
dures that have been shown to enhance quality of life? Profes-
sional codes of ethics obligate us to become more effective
marketers of interventions that enhance quality of life. Relying
on what feels right or what we believe, unaccompanied by a
well-reasoned argument and/or by evidence, is incompatible
with obligations described in ethical codes.
Obstacles
We can use our contingency analysis skills as well as research
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.
The Allure of Mentalism (Mentalistic Explanations)
Mentalism can be defined as ‘‘an orientation to the study of
behavior, which holds that a unique, a necessary, and the pri-
mary contribution to the causal explanation of behavior con-
sists in proposing various internal acts, states, mechanisms or
processes, presumed to be operating in neural, conceptual, or
psychic dimensions’’ (Moore, 1990, p. 20). Mentalistic expla-
nations ‘‘appeal to the initiating causal efficacy of feelings,
mental states, attitudes, thoughts, ideas, drives, needs, mem-
ories, images, representations, sensations, reasons, purposes,
beliefs, wants, desires, attributions, the ego/superego/id,
moods, brain states, expectations, etc’’ (p. 20). Radical beha-
viorism was termed radical because it is a sharp break with
methodological behaviorism. Private events such as feelings
and thoughts are viewed as behaviors that themselves need
explanation. This seemingly simple statement is profound in its
implications. This means that we cannot use feelings and
thoughts as explanations for behavior as occurs in mentalistic
accounts; we must examine environmental contingencies.
Those who favor mentalism appeal to cognitive processes such
as thoughts to explain behavior. There is a focus on interiors.
Appeal to interiors (thoughts, feelings, and brains) draws
attention away from environmental contingencies that contrib-
ute to social and personal problems. If we examine what most
cognitive–behavioral therapists do, I suspect that we would
find that two thirds of their endeavors focus on interior events
and their modification (such as changing what clients say to
themselves). (This could be checked by an empirical investiga-
tion of what is focused on in published studies as well as by col-
lecting new data describing the focus of intervention.) Factors
that encourage mentalism include the vividness of thoughts and
feelings, the ideology of success via ‘‘mind power,’’ and frag-
mented accounts in the media which ignore environmental
causes (Gambrill, 1992). We are often aware of our thoughts
and thus they are readily available to view as the cause of beha-
viors and events that befall us in our lives. The same can be said
of our feelings. These too are readily available. (See also later
discussion of cognitive biases.) This availability, combined
with the tendency to think that we have discovered the cause
(and thus the remedy) regarding behaviors or consequences
of interest, lull us into thinking we have discovered how to
change things for the better. There is an illusion of understand-
ing. If this is not true, they are false prophets (a kind of false
positive) which get in the way of further inquiry.
A focus on interiors encourages a disinterest in the behavior
of clients and related environmental circumstances. An indica-
tor of a disinterest in individual circumstances and characteris-
tics is illustrated by use of brief (one paragraph or one page)
124 Research on Social Work Practice 23(2)
vague summaries describing a client assumed to offer enough
information to understand a client’s life (e.g., warranting deci-
sions about what is wrong and what should be done). Lack of
understanding of unique individual situations encourages a lack
of empathy for clients. Where is the empathy for a child when
we simply give him a label and prescribe medication, as occurs
for so many school children? Children in foster care are espe-
cially likely to be medicated (Carey, 2011; Government
Accountability Office, 2011). Professionalcodes of ethics call
for use of the least restrictive interventions; medication is usu-
ally not the least restrictive. Sperber (1990) argues that opinion
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).
Bauer (2012) argues that research cartels censor well-argued
alternative views and promising directions of inquiry.
Related popular grand narratives and metaphors. It is widely
believed that ‘‘mental illness’’ is the cause of troubled, trou-
bling, and very dependent behaviors. Indeed, to question this
belief is often viewed as heretical and deluded. The biomedical
industrial complex has had phenomenal success in framing
problems as internally caused with the aid of its best friend, the
Diagnostic and Statistical Manual of Mental Disorders (DSM;
American Psychiatric Association, 2000), soon to appear in its
fifth edition (Gambrill, 2012a). Biomedical explanations are
used to account for an ever-increasing range of behaviors,
thoughts, feelings, and bodily conditions. (Mis) behaviors,
troubled or troubling feelings and thoughts are translated into
illness such as bipolar disorder, schizophrenia, ADHD, and
hundreds of others including gambling and female sexual dys-
function (Moynihan & Mintzes, 2010). This category error,
assuming that behavior—what people do—equals illnesses, is
widely ignored by players in the mental health industry and
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-
terizes this enterprise. The boundaries around categories of
alleged disorders such as anxiety in social situations continue
to expand. The promotion of the belief that deviant or troubling
behaviors are caused by an illness (a brain disease) has
spawned scores of industries and thousands of agencies, hun-
dreds of research centers, and thousands of advocacy groups
which forward this view. A disease model of alcohol abuse
rules the day. Szasz (2001) argues that we live in a therapeutic
state (a pharmacracy) characterized by psychiatric control of
misbehavior by prescribed or coerced medication.
The therapeutic grand narrative of clinical psychology
focuses on the self as the prime site for management of life’s
travails. Illouz (2008) argues that an ideal of social communi-
cation was created, incorporating the view that we gain self-
knowledge by introspection which can provide guidance in
understanding, controlling, and dealing with both our social
and our emotional environment. Verbal disclosure was viewed
as central in social relations. Self-observation, self-knowledge,
and the responsibility to work on and alter our relationships are
emphasized. Illouz suggests that the language of therapy has
been responsible for a cognitive and cultural process of ‘‘verbal
overshadowing’’ that makes self-introspection a substitute for
nonverbal ways of acting in social exchanges. Does this focus
on interiors have a beneficial outcome? Her answer is ‘‘No.’’
She contends that questions about ‘‘Why do the innocent suffer
and the wicked prosper? . . . that [have] haunted world religions
and modern social utopias, [have] been reduced to an unprece-
dented banality by a discourse that views suffering as the effect
of mismanaged emotions or a dysfunctional psyche or even as
an inevitable stage in one’s emotional development’’ (p. 246).
Seduction by Theory
Some professionals focus on interpreting and explaining beha-
vior. They may say they understand an event if an explanation
‘‘makes sense to them.’’ Different goals (interpretation and
explanation or understanding based on successful prediction
and influence) reflect different views of understanding and
explanation. The professional literature in the interpersonal
helping professions is replete with books and articles describ-
ing different theories regarding behavior, with little attention
to practical utility in helping people to enhance the quality of
their lives. Qualifying examinations in social work in the
School of Social Welfare at UC Berkeley examine students
on their knowledge of a range of theories with seeming little
interest in their practical utility. Indeed, in a recent doctoral
qualifying examination bibliography on theories of the family
approved by a faculty member, there was no mention of social
learning theory, arguably, the most widely drawn on to design
effective assessment and intervention programs. Nettler (1970)
suggests that illusions of explanations are accepted when it is
more reinforcing to select empathic (based on feelings) or ideo-
logical (based on beliefs) accounts.
The Allure of Pathology
The DSM is one of the most successful (if not the most success-
ful) technologies in the history of mental health. It provides
about 5 million dollars a year to the American Psychiatric
Association and is soon to appear in its fifth edition with even
more labels applied to even more behaviors. Such a technology
fits with a disease model of deviant behavior and a focus
on ‘‘the self.’’ Related discourse makes creative use of look-
alikes for science (pseudoscience and scientism; e.g., Boyle,
2002) and encourages a disregard of individual differences in
opportunities and challenges. It has become accepted (and
more reinforcing) to ferret out interesting psychopathologies
related to complaints than to discover environmental contin-
gencies that affect what people do, think, and feel and contrib-
ute to positive change. Central in applications of behavioral
analysis to clinical and social problems is the view that ‘‘beha-
vior always makes sense.’’ But this sense may only be revealed
via an understanding of related contingencies. This view is
quite the opposite of the grand narratives of clinical
psychology and biomedical psychiatry which emphasize
Gambrill 125
deficiencies—their identification and causes, usually in the
individual, spurred on by Big Pharma, piggy backing on the
ever expanding DSM. Third-party payment requires use of
these diagnostic categories. Research grants must use such
classifications. The field of psychopathology is enormous
with subfields in child, adult psychology, and geriatric
psychopathology. The prefix ‘‘psych’’ emphasizes the
psychological—the individual—what lies within; the term
pathology focus on what is wrong. We hear these words
endlessly which influences how we frame problems and
attempt to solve them.
Misunderstandings of Science
ABA is a scientific approach to understanding and altering beha-
vior. Behaviorism is ‘‘a philosophy of science concerned with
the subject matter and methods of psychology’’ (Skinner,
1988, p. 278). Many objections to ABA are related to misunder-
standings of science. Philosophy of science is a neglected area in
most professional schools. Science is a way of thinking about
and investigating the accuracy of assumptions about the world.
It is a process for solving problems in which we learn from our
mistakes. Science rejects a reliance on authority (e.g., pro-
nouncements by officials or professors) as a route to knowledge.
Authority and science are clashing views of how knowledge can
be gained. Surveys show that most people do not understand sci-
ence (National Science Foundation, 2006). Misunderstandings
about science may result in ignoring this problem-solving
method and the knowledge it has generated to help clients
enhance the quality of their lives. Textbooks often omit contro-
versy giving an illusion of a logical progression of uncomplex
discovery, when indeed, the process is quite different, involving
chance discoveries, conjecture, and controversies. Journal arti-
cles often omit controversy about causes and evidence. Science
is often misrepresented as a collection of facts or as referringonly to controlled experimental studies. Many people confuse
science with pseudoscience and scientism.
Scientific thinking rejects a search for final answers. It is
hard to give up illusions of control that are questioned by ask-
ing for evidence. Scientific thinking may thus interfere with
one of the functions of lay beliefs—making the world a stable,
orderly, and predictable place (Furnham, 1988). Thinking criti-
cally about the causes of a problem such as poverty or sub-
stance abuse may call into question comfortable positions. If
you can no longer blame the people who have the problems,
maybe something should be done to alter environmental cir-
cumstances related to these problems. Far from reinforcing
myths about reality, science is likely to question them. All sorts
of questions that people may not want raised may be raised,
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
about ——?’’ Misunderstanding about science may result in
ignoring this problem-solving process. Some people believe
that the scientific method is inappropriate to apply to human
behavior. Reasons given include the assumption that behavior
is variable and cannot be controlled or influenced in a systema-
tic way. It is believed that behavior is essentially unknowable.
Knowledge about behavior is indeed incomplete. This may
breed a dissatisfaction and impatience with the slow pace at
which a science of behavior develops or result in a belief that
a science of behavior is not possible. The incompleteness of
knowledge often encourages theorizing about why technology
is incomplete rather than continued experimental efforts to cre-
ate additional knowledge (Baer, 1991).
Countervailing Contingencies and a Reluctance to Reveal
Them
Sociologists and cultural observers such as Foucault (1973),
Illouz (2008), and Szasz (2001) bring to our attention the influ-
ence of the state and related institutions such as welfare pro-
grams and prisons on what problems receive attention (and
which ones do not) and remedies proposed. Health insurance
companies are interested in saving money as reflected in a
reluctance to pay for interventions shown to be effective for
children with developmental disabilities. Managed care poli-
cies may not support effective interventions nor may policies
and practices in schools and other kinds of institutions (child
welfare departments). The helping professions are big business
(see Stid, 2012). Consider the multibillion dollar pharmaceuti-
cal industry. Consider the huge assessment industry. Hundreds
of schools graduate thousands of social workers, counselors,
and psychologists each year. Most professionals are unin-
formed regarding ABA and related research, theory, and philo-
sophy and its application to the pursuit of outcomes clients
value. Thousands of social workers graduate each year from
bachelor’s, master’s, and doctoral degree programs with a pris-
tine ignorance of ABA and related theory. All these enterprises
exist because of maintaining contingencies. Many interested
parties go out of their way and devote considerable resources
to hide context (what is done to what effect). Consider exposure
of conflicts of interest including those of academic researchers
(Lo & Field, 2009). Behaviorism is radical in closely examin-
ing context and related contingencies, taking advantage of
observation when possible. Who is reinforcing whom for what
behaviors with what consequences? Description of involved
contingencies, some of which may facilitate and others of
which may hinder change (exert counter control), are important
to identify in order to select valuable entry points and behaviors
and contingencies to alter. Are there entry points such as con-
sumer groups which may encourage a positive cascade effect?
How can we avoid entry points which encourage the opposite,
negative cascade effects which result in development of even
greater countercontrol?
The Plethora of Propaganda in the Helping Profession
Propaganda refers to encouraging actions, adherence, and par-
ticipation with as little thought as possible (Ellul, 1965, p. 180).
Propaganda can be contrasted to critical thinking—arriving at
well-reasoned beliefs and actions (Gambrill, 2012b). Common
126 Research on Social Work Practice 23(2)
methods include censorship, distortion, confusion, and even
fabrication. As Rank (1982, 1984) suggests, we highlight the
positives of our view, hide the negatives, and highlight the
negatives of competing views and hide the positives. Consider
distortions and misrepresentations of behavioral methods (e.g.,
Thyer, 2005) and of evidence-based practice (Gambrill, 2011).
ABA involves a constructional approach to change in which
there is a focus on constructing repertoires including those
which compete successfully with undesired behaviors (Goldia-
mond, 1974, 1984; Schwartz & Goldiamond, 1975). Descrip-
tions of ‘‘strength perspectives’’ in social work typically
ignore related literature and falsely claim that their model is
unique in focusing on client assets. Related books also illustrate
the ‘‘picking off’’ of behavioral strategies unrelated to their the-
oretical underpinning.
Ellul (1965) argues that propaganda is integral to the techno-
logical society in which we live. (See also Ellul, 1964.) Propa-
ganda offers an escape from the alienating effects of such a
society, such as anxiety and loneliness. We have a ready ideol-
ogy that offers a reason for our miseries and an excuse for our
actions. Our psychological vulnerabilities, for example, to ‘‘be
right,’’ to be ‘‘one of the in-crowd,’’ contribute to the success of
propaganda. Propagandists influence our choices by how they
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
‘‘pediatric bipolar disorder’’ and promoting neuroleptic medi-
cation for toddlers has resulted in a vigorous backlash (e.g.,
Angell, 2009; Lo & Field, 2009). Self-propaganda is intimately
related to propaganda from other sources; the two become
closely intertwined, encouraged by years of prepropaganda in
our schools (Ellul, 1965). Consider the progression of students
through their education. By the time they arrive in professional
degree programs, they may have had little experience and men-
toring in close observation of environmental influences and a
great deal of practice using mentalistic descriptions.
Hiding well-argued alternative views may result in misdirec-
tions and oversimplifications that mislead rather than inform us
about what is a problem, what kind it may be, what causes it, and
what can be done (if anything) about it. Consider ignoring
research concerning the role of therapist alliance and allegiance
in contributing to positive outcome in publications overpromot-
ing ‘‘evidence-based’’ practices. (For discussion of the role of
such factors see Duncan, Miller, Wampold & Hubble, 2010;
Norcross & Lambert, 2011; Wampold, 2007.) We see inflated
claims of accuracy and evidentiary status regarding favored
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
to our self-interests in being healthy, popular, right-living,
achieving the good life, and avoiding the bad. Ignorance of ABA
enables related propaganda to be effective; propaganda
flourishes where ignorance reigns. Propagandists are skilled in
use of strategies such as distracting our attention from the lack
of evidence for claims by name dropping (e.g., ‘‘as Freud said’’),
bogus citations (they contain no support for the related claim),
and censorship of well-argued competing views. These skills
may be polished ingraduate school. Both advertisements and
content in the professional literature distort reality by selective
presentation of data to forward a certain view and related product
and use similar techniques to do so. Similar goals and strategies
are evident in both (Gambrill, 2012a). Both create an illusion of
knowledge and achievement of valued goals. We see our usual
propaganda ploys—bold assertions including inflated claims
about ‘‘what we know,’’ and ‘‘what works’’ or what is done, hid-
ing context such as well-argued alternative views, distorting
facts and figures, and appeals to authority such as uncritical doc-
umentation (attaching citations to a claim without any descrip-
tion of what these citations contain). There seems to be a
negative correlation between the status of a profession and the
tendency to publish advertisements disguised as research articles
(marticles). That is, the lower the status, the more marticles
appear, as in social work and psychiatry compared to medicine.
Altheide and Johnson (1980) argue that the greatest source of
propaganda today is bureaucratic—endless agency reports
designed to gain or continue funding which reveal little detail
regarding what is done to what effect. The old adage ‘‘Buyer
beware’’ can be generalized to be critical of what you read, even
in professional texts and journals.
Gullibility
We are gullible creatures as any history of science, ideas, fash-
ion, or just about anything else would testify (e.g., see Cialdini,
2009; Thyer & Pignotti, 2010, 2011). We are easily deceived,
duped, or cheated. Some hoaxes are so successful they have
been practiced for centuries. Many persuasive appeals play
on our emotions as in appeals to special interests or disliked
groups. The ad-like character of much material in the profes-
sional literature (articles, chapters, and texts) in tandem with
common biases to which we are subject such as overconfidence
and confirmation biases, increase the likelihood that we will be
bamboozled. For example, our belief in a view may result in
missing or dismissing methodological limitations in studies
favorable to this view, especially when they are minimized
or ignored by authors. This contributes to an illusion of
learning—an illusion of knowledge acquisition and dissemina-
tion. We may not know that articles we read were written by
ghostwriters hired by pharmaceutical companies but published
under the name of a well-known academic. Gullibility has
many advantages. Time is saved, sure answers are claimed, and
one can belong to a subgroup of fellow believers.
Misleading Use of Language
Language may mislead us because of carelessness, lack of skill
in writing and thinking, or deliberate intent to mislead on the part
of a speaker or writer. Unless we are skilled in avoiding the
misleading influence of words, our lives may be shaped by the
words we use, see, and hear in ways that harm rather than help.
Applied behavior analysts have devoted considerable attention
to equivalence relations and their effects (e.g., Dymond, Roche,
Gambrill 127
Forsyth, Whelan, & Rhoden, 2007; Sundberg &Michael, 2001).
Just as thought may corrupt language, language may corrupt
thought (Orwell, 1946/1958). ‘‘Weasel worlds’’ provide an illu-
sion of argument or clarity. Examples include
� ‘‘Many people say . . . ’’ How many? Who says so? On what
basis?
� ‘‘Some people argue that . . . ’’ Who? On what basis?
� ‘‘Studies show . . . ’’ What studies? How sound are they?
� ‘‘Experts suggest . . . ’’ What experts? On what basis?
� ‘‘It is notable that . . . ’’ On what basis is it notable?
� ‘‘Obviously . . . ’’ How is it obvious? What is the evidence?
Weasel terms such as ‘‘it is well known that . . . ’’ ‘‘It is widely
accepted that . . . ’’ (when indeed there is controversy) are used
in lieu of arguments. We may believe that because a word
exists, what is referred to exists (reification). The terms science
and scientific are often used for persuasive rather than descrip-
tive purposes. That is, the term scientific is often used as an
adjective to enhance the credibility of a view or approach even
though no scientific evidence is available that supports the
view. The term science has been applied to many activities that
in reality have nothing to do with science. (See also critiques of
‘‘evidence-based practice,’’ Gorman & Huber, 2009).
Combs and Nimmo (1993) describe palaver as a kind of dis-
course in which truth and falsity are irrelevant. It includes ram-
bling speech and digressive claims presented in appealing
ways. Obscure writing often appears more profound than clear
writing. Armstrong (1980) found that material presented in
obscure wording was deemed more profound and scientific.
In palaver, truth is irrelevant. There is no concern for truth, only
to create credibility and for guile and charm. As Frankfurt
(1986) suggests, ‘‘he does not reject the authority of truth, as
the liar does, and oppose himself to it. He pays no attention
to it at all’’ (cited in Combs & Nimmo, 1993, p. 340). Frankfurt
suggests that faking is inevitable whenever circumstances
require that we speak without knowing what we are talking
about. In advertising and in professional publications, palaver
is used to make small or no difference between products look
substantial to encourage us to purchase one product rather than
another. This is also the case with alleged differences among
the hundreds of psychotherapies available. We are complicit
in perpetrating this reign of palaver in our failure to be skepti-
cal. Problems are viewed as solvable via discourse—expres-
sions of concern and description of efforts. The problem
actually remains but is ‘‘solved’’ for the politician because pro-
paganda produces the desired effect on the public (Combs &
Nimmo, 1993, p. 236). Thus, problems are viewed as ‘‘a prob-
lem of propaganda.’’ Propaganda is the solution to political or
other organizational problems because it creates a semblance
of reality.
The Prevalence of Cognitive Biases
Trying to solve problems is influenced by what we observe and
what we do not; what theories we prefer and which ones we are
unaware of or do not like. Failure to recognize environmental
influences is a key reason distortions and misrepresentations
of ABA and radical behaviorism are so readily accepted. As
Skinner (1971) suggests, ‘‘casual observation alone will sel-
dom reveal the contingencies’’ (p. 148). Patterns of reinforce-
ment that affect behavior are not obvious. If environmental
influences were more vivid, their role would be more difficult
to deny and disregard, including contingencies related to beha-
viors that could successfully compete with those complained
of. What conditions contribute to ignoring environmental vari-
ables? Why did people not ‘‘see’’ the ape crossing the stage
(see Ariely, 2009). We can draw on theory and research con-
cerning decision making and related cognitive biases and illu-
sions to help us understand why environmental variables tend
to be ignored (Gambrill, 2012b; Pohl, 2004). Examples of cog-
nitive biases include confirmatory biases in which we seek only
information compatible with our preferred views and wishful
thinking (e.g., Taber & Lodge, 2006). We often mistake corre-
lation for causation and causes and their effects. We underesti-
mate the role of chance and are subject to the fundamental
attribution error (attending to personality characteristics of
individuals and overlooking environmental variables). We tend
to ignore base rate information and are subject to hindsight
bias. Either-or thinking may lead us astray—considering only
two alternatives when there are more. We are subject to the
‘‘validity effect.’’ This occurs when the mere repetition of
information affects the perceived truthfulness of that informa-
tion (Renner, 2004).
In everyday life, we often attribute behavior to feelings and
thoughts. A counselor may writein her record, ‘‘Mrs. Jones
tried to kill herself because she felt lonely and believed no one
cared about her.’’ But, why did she feel lonely? Why did she
believe no one cared about her? Such accounts stop too soon.
They are incomplete. What is going on in her life that may
be related to feelings, related thoughts, and the suicide attempt?
Feelings and thoughts are vivid, thus readily available to
assume as causes of behavior. Propagandists take advantage
of this vividness to encourage confusion between feeling free
and being free. They may pronounce: ‘‘You are free to
choose,’’ when, because key information is hidden and alterna-
tives offered have been shaped by others, you are not free. As
Skinner (1971) suggests, just because you feel free does not
mean you are uninfluenced by your environments. Environ-
mental circumstances are less vivid, and so easily overlooked,
especially by professionals who rely on clients’ self-report in
interviews (the office-bound professional). So too is our past
history (biographies that shape our behavior) typically less
vivid unless focused on, as in certain kinds of therapy. The
reinforcement history of complained of behaviors (or their
lack) is hidden in the past. We see only its reflections in the
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
are thousands of reinforcement occasions for troubling or
troubled behaviors and perhaps even more lost opportunities
to reinforce desired alternatives. Our tendency to be influenced
128 Research on Social Work Practice 23(2)
by vivid events such as feelings draws attention away from the
environment. If we are not trained to think about ‘‘reinforce-
ment history’’ but have taken courses focused on theories of
development, mentalistic concepts such as low self-esteem
may leap to mind as causes of complained behavior with their
implication of a focus on interiors (raising self-esteem).
Alternative repertoires related to vivid complained-of beha-
viors such as phobias, compulsions, hallucinations, temper tan-
trums, and bullying are not obvious without the conceptual
orientation to seek them and the technical skills to discover
them (e.g., by having clients complete daily logs regarding
what they do and related circumstances; Schwartz & Goldia-
mond, 1975). Nor are maintaining contingencies of disliked
behaviors obvious; the form of behaviors such as tantrums cap-
tures our attention. The form of a behavior may not reveal its
function. Without recognizing this vital distinction, we may
assume that alternative repertoires which may compete suc-
cessfully with an undesired behavior must look similar when
indeed, totally different forms of behavior may be maintained
by the same reinforcer. What doctor would jump to a conclu-
sion that a fever indicated a certain cause, that a rash was due
to a certain cause, or that shortness of breath was caused by a
particular circumstance? Yet in the interpersonal helping pro-
fessions, we see such ‘‘jumping to conclusions’’ everyday.
Consider the acceptance of ‘‘past trauma’’ as the cause of a
wide variety of problems.
Lack of Critical Thinking Skills and Related Dispositions
Problems may be created or remain unsolved because we rely
on questionable criteria to evaluate claims about what is accu-
rate, such as tradition, popularity, or authority (Gambrill,
2012b). Thinking critically about claims is not valued by many
groups and individuals. To the contrary, individuals and/or
groups may try to hide the effects of practices and policies
by relying on propaganda methods and appealing to pseu-
doscience as suggested earlier. Phillips (2000) argues that rais-
ing questions about ‘‘truth’’ has the taboo quality today that
talking about sex had in Victorian times. Both critical thinking
and evidence-informed practice and policy encourage asking
questions designed to make the invisible visible, including
uncertainties and inequities related to decisions (e.g., see Data-
base of Uncertainties About the Effects of Treatments
(DUETS) at http://www.library.nhs.uk/duets/).
The Press for Efficiency and Standardization
Ellul (1965) argues that ‘‘modern man is obsessed with tech-
nology’’ (p. 59). Technology strives for ever greater standardi-
zation and efficiency. Pains and symptoms must be classified
so forms can be easily completed and resultant classifications
given Latin names so they give the illusion of objectivity. Do
standardized measures accurately reflect quality of life (e.g.,
Carlon et al., 2010; Mularksi et al., 2007)? Does observation
in real-life settings provide a corrective guide?
The push for efficiency and standardization creates an erasure
of individual differences (Illouz, 2008). Both children in foster
care and the elderly are too often placed on medication rather
than understanding and altering contingencies related to their
behavior (e.g., Government Accountability Office, 2011; Levin-
son, 2011). Parent training programs that clients receive in child
welfare services are not those most likely to be effective (e.g.,
see Barth et al., 2005). Assessment is minimal; everyone may
receive the same program. Consider the example of a child wel-
fare worker called out to a home in which there was concern
about abusive parenting practices. Upon arrival of the social
worker at the home, the father said, ‘‘No, wait’’ and rushed into
another room and brought out four certificates that he had
received from attending four different parenting programs. This
example illustrates the ritualistic nature of a great deal of inter-
vention and the related enormous waste of money. Also, given
that such interventions are ineffective or harmful, they may cre-
ate an illusion of knowledge (a parent may think they know more
when they do not) or (even worse) contribute to a believe that
one is ineducable. With the money saved from not offering inef-
fective or harmful programs, we can train staff to offer effective
programs. In contrast, ABA is deeply concerned with individual
differences in learning histories and current contingencies and
related implications for selection of interventions. ABA requires
attention to real-life worlds in which a client lives. But this takes
time. It takes skill in observation. Who will pay? Who will suffer
if payment is not forthcoming?
Codes of Ethics Without Creating Related Controlling
Conditions Offer an Illusion of Ethical Practices and
Policies
Every profession has a code of ethics describing obligations of
practitioners. These codes call on those in a profession to help
clients and avoid harming them and to involve them as
informed participants. Given harming in the name of helping
and the fact that most clients are not involved in helping efforts
as informed participants, clearly these codes alone are not
effective in influencing behavior. Indeed, it could be argued
that they do more harm than good because their existence, in
the absence of the necessary controlling conditions to ensure
they are honored, conveys an illusion that practitioners are
doing the right thing, just as a bogus certification on a food
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
clients are not misinformed or uninformed, but involved as
informed participants? What conditions would have to be
established to ensure that practitioners accurately describe their
competence to clients/patients? Should we use a form similar to
one suggested by Entwistle and her colleagues which requires
professionals to clearly describe to clients the evidentiary status
of services offered compared to alternative methods as well as
the track record of success of those who will offer them
(Entwistle,Sheldon, Sowden, & Watt, 1998)?
Gambrill 129
Exactly what behaviors in what circumstances are required
regarding each ethical obligation? What circumstances require
deviations (alternative behaviors)? What is the range of beha-
viors (the operant) that results in a specific related hoped-for
outcome? To what degree do those behaviors identified as
‘‘ethical’’ facilitate positive outcomes for clients and signifi-
cant others? To what extent does a client’s view of positive out-
come overlap with the views of significant others?
A Path Ahead
We can do more to encourage greater use of a science of beha-
vior and related theory to help people to enhance the quality of
their lives. And, as suggested earlier, we are ethically obligated
to do more. What should this ‘‘more’’ consist of to maximize
success in decreasing gaps between what is likely to help cli-
ents attain valued outcomes and what is done? How can we
encourage clients to advocate for and professionals to take
advantage of methods that improve quality of life for clients
and significant others (e.g., see Risley, 1996)? How can we
make theory and technology that helps clients more interesting,
indeed of vital appeal? If ABA and quality of life are birds of a
feather, we must raise our appeal to many different audiences.
A great deal of this ‘‘more’’ consists of revealing avoidable
ignorance as suggested in the sections that follow. We should
help both professionals and clients to see what is not obvious
(what is hidden) such as conflicts of interest that maintain inef-
fective (or harmful) service programs and consequent avoid-
able suffering and waste of money (e.g., see Tanne, 2012).
Ignoring individual differences in unique alternative available
repertoires (AARs) and life circumstances and histories
decreases the likelihood of understanding clients, including
their individual subjectivities. This calls for revealing avoid-
able ignorance. Proctor and Schleibenger (2008) suggest that
the study of ignorance is as important as the study of knowl-
edge. All professional schools should introduce students to the
tapestry of ignorance that influences their work with clients and
related consequences. We can help people think like Sherlock
Holmes who noticed the importance of the fact that the dog did
not bark. We can help parents to see that the quietness of a child
should be an occasion for a loving hand or fun game rather than
for continuing to Twitter or text. We can help an inattentive
spouse to notice the yearning of his or her partner for attention,
so removing the need to seek attention via fears and obsessions.
Reveal Avoidable Suffering Due to Gaps Between What
Could Be and What Is Done
Revealing avoidable suffering is a key way to gain media atten-
tion and interest of involved decision makers, to recruit con-
sumer support and to recognize ‘‘crises’’ (opportunities for a
positive cascade effect). Indicators of poverty, stress, and
deprivation are becoming more specific. Examples include per-
centage of children not enrolled at appropriate educational lev-
els, living in dwellings with no electricity, absence of safe
drinking water, not having toys, and not having at least one
book (Roelen & Gassman, 2012). Measures of child well-
being include many of these in addition to indicators such
as proportion of children who report being beaten or insulted
as part of punishment/discipline and percentage of children
who report having a good or very good relationship with a
peer (Hoelscher, Richardson, & Bradshaw, 2012, see also
Maholmes & King, 2012). We should make the avoidable suf-
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-
quences (e.g., those with nothing to do)? Although many more
children come into care because of neglect, most research
attention is focused on abuse. Neglect is not as vivid because
we do not make it so. Do we count the hours when a child is
emotionally and cognitively neglected? In ‘‘Meaningful dif-
ferences,’’ Hart and Risley (1995) gathered data regarding the
verbal environment in 3 distinct SES (socioeconomic status)
categories: professional working, and welfare. Sizable differ-
ences were found in the frequency of words spoken by parents
to their children. ABA is in part a science of minimizing
avoidable suffering.
Exposing avoidable suffering on a steady basis in multiple
areas would hopefully potentiate concerns about these negative
consequences and generate effective countercontrol to change
circumstances. This is especially needed in settings in which
options for countercontrol on the part of those experiencing
adverse effects are limited. As Skinner (1971) notes, ‘‘those
who are concerned for the welfare of people in mental hospitals
and many other institutional settings, including prisons often do
not know what is happening in such settings because control
and countercontrol tend to become dislocated when control is
taken over by organized agencies’’ (p. 171). Ignorance is the
controllers’ and the propagandists’ friend. Appeal to feelings,
states of mind, and mental illnesses allow the former to mystify
sources of avoidable suffering (place causes in the individual).
Such appeals obscure alternative accounts that may reveal
needed changes in environmental contingencies. As Skinner
(1971) suggests, ‘‘Young people drop out of school, refuse to
get jobs, and associate only with others of their own age not
because they feel alienated but because of defective social
environments in homes, schools, factories, and elsewhere’’
(p. 15). We have let clients and their significant others as well
as professionals down, by not making greater efforts to make
visible lost opportunities to help clients minimize avoidable
suffering.
What percentage of fourth graders referred to a social
worker for out-of-control behavior in the classroom are recipi-
ents of a functional assessment (see Cipani, 2012) and what
percentage receive intervention based on this assessment
including at least a 6-month follow-up to maintain gains? What
percentage are helped by this approach at what cost? What per-
centage of children receive other kinds of services and what
percentage are helped by these? What percentage are not and
at what costs (e.g., social, emotional). This kind of data would
allow us to identify and expose gaps between what is and what
should be as well as their consequences such as avoidable
130 Research on Social Work Practice 23(2)
suffering and loss. In exposing these gaps, we should try to cap-
ture multiple kinds of costs and benefits, both current and
future, including emotional, economic, and social costs of one
intervention compared to another, both now and in the future.
Let us say that a behavioral approach based on findings from
the experimental analysis of behavior is more effective than
other methods to achieve certain outcomes. We could trace
possible consequences over just 1 month. How many lost
opportunities for reinforcement of positive behaviors result
from each day in different programs? What is the rate per day?
What is the rate for the child, the teacher, other members in the
class, and the child’s parents? How many avoidable instances
of punishment resulted from different programs? What is the
overall positive to negative ratio in terms of consequences
maintaining behavior? What kind of ‘‘tipping’’ points occur
(e.g., reinforcement patterns/schedules that tip a person into a
depression or state of elation)? What kind of positive or nega-
tive cascades occur and under what kinds of circumstances?
Psychological distress affects mortality and enjoyment of
everyday life (e.g., see Russ et al., 2012).
In modern times, it seems that journalists are most likely to
blow the whistle on harmful interventions and their effects
including punitive, neglectful conditionsin group homes for
those labeled ‘‘mentally ill,’’ those with developmental disabil-
ities, and those for the elderly, many of whom spend their last
days in vapid nursing homes, overmedicated and undertouched
and uncared for (e.g., Levy, 2002). Popper (1994) suggests that
we do not know how to make people happy but that many
would agree on what is avoidable suffering. He proposed an
agenda for public policy consisting of ‘‘ways and means of
avoiding suffering, so far as it is avoidable’’ (p. 124). For com-
plaints that reflect avoidable suffering we should do the
following
1. Clearly describe it as well as common related contingen-
cies. Who is to say what avoidable suffering is? Adapta-
tion to low levels of positive reinforcement may result in
a lack of complaints. People are remarkably adaptable
and creative in responding to changing levels and kinds
of reinforcement. This very adaptiveness may result in
the slow withering of verbal complaints and perhaps even
signs of distress as scanty reinforcement schedules result
in a profound resignation reflected in silence and possible
quietness as in those sitting or laying in nursing homes. In
the absence of verbal complaints which such histories
may reflect, we must use our eyes to see avoidable mis-
eries. Here too, the behavioral literature suggests valid
observational methods and possible interventions to
entice the demoralized (such as reinforcer sampling). Our
adaptiveness is shown by those whose environments
encourage behavior viewed as deviant (e.g., selling
drugs) as in poor neighborhoods with few opportunities
for valued employment (Wacquant, 2009). Would we too
come under the influence of such contingencies? Focus-
ing on avoidable suffering highlights the importance of
attending to opportunities for reinforcement. Where there
are few opportunities, there will be little behavior, includ-
ing perhaps, even complaints.
2. Determine its prevalence.
3. Determine if there is an effective intervention. Is there a
recent Cochrane or Campbell systematic review addres-
sing the issue? A question here is who is to say what is
effective? (See prior discussion of social validity.)
4. Estimate the percentage of individuals who have the com-
plaint (or are complained about) who receive effective
intervention.
5. Conduct a cost–benefit analysis regarding the conse-
quences of providing (or not) effective intervention in
relation to prevalence drawing on our values and technol-
ogy related to social validity to capture the subjective as
well as objective consequences in order to accurately por-
tray seriousness and impact (e.g., avoidable suffering and
lost opportunities for reinforcement; See Table 1).
6. Conduct a contingency analysis to determine factors
related to gaps discovered. Who benefits from current
patterns of reinforcement? Who loses? Who makes money
by providing ineffective services to clients/students?
7. Conduct an ethical audit regarding what is found in five
and six highlighting kinds, frequencies, and intensities of
avoidable suffering and interrelationships among them.
Table 1. Avoidable Suffering: Children With Developmental Disabil-
ities in Oakland California.
1. Description of specific problem/need.
2. Estimated prevalence of each.
3. Are there effective interventions for each: ___yes ___ noa
4. Percentage of children who obtain effective interventions in a
timely manner for each problem/need. ___%
5. Cost–benefit analysis of consequences of gaps between
knowledge available and what is used regarding each problem/
need.
a. For individual children and their significant others (e.g., peers,
teachers, family members):
� Lost opportunities for positive reinforcement of different
kinds (e.g., social approval, fun) and consequences.
� Lost opportunities for acquisition of new repertoires and
related effects.
� Lost opportunities to avoid adverse consequences and
related effects.
b. Benefits and costs to taxpayers both now and in the future.
c. For professionals.
� Lost opportunities for profit from offering ineffective and/
or harmful programs.
� Lost opportunities to gain satisfaction by reducing
avoidable suffering.
6. Descriptive analysis of factors related to gaps.
� Avoidable suffering due to gaps.
� Who gains what from current patterns of services?
� Who would gain and lose what from decreasing gaps?
7. Ethical audit of consequences of gaps drawing on five and six
based on obligations in professional codes of ethics.
8. Plan for sharing information with media and decision makers.
9. Plan for decreasing avoidable suffering.
aIf not, does prevalence warrant a high priority for research.
Gambrill 131
8. Widely share this information with the media and deci-
sion makers in varied venues including a user-friendly
website (see later discussion). Transparency International
ranks all countries in terms of prevalence of corruption
(www.transparencyinternational.org). We could create a
list of programs ranked in terms of prevention of avoid-
able suffering. Exposure of avoidable suffering and other
harmful effects such as waste of scarce resources result-
ing from continuing to provide ineffective services and
the related deceit, greed, and indifference will encourage
change. Indeed, the gross excesses of the biomedical
industrial complex in terms of fraud and conflicts of
interest have resulted in a vigorous backlash (e.g., see
Pharmedout.org, healthyskepticism.org).
9. Identify and alter contingencies to increase effective
services and decrease ineffective and harmful ones.
A descriptive analysis will suggest entry points for
change. Change at many levels may be required,
including professional education, institutional settings,
and managed care companies. See, for example, Malott
and Glenn’s (2006) discussion of macro and meta-
contingencies. In doing so, we can draw on the research
findings from the experimental analysis of behavior, both
in the laboratory and in the clinic and other sites such as
schools and hospitals. Changes in dysfunctional
education programs and accreditation methods may be
required and/or alternatives developed (e.g., see Baker,
McFall, & Stroham, 2008; McFall, 2012; Stoetz, Karger,
& Carrilio, 2010). The exposure of avoidable suffering
may be required to overcome countercontrol by those
involved (e.g., professors in social work education
departments; principals in schools, administrators in
hospitals, prisons, and managed care companies).
10. Report successes and failures and ‘‘try again’’ in an
iterative process over time.
If doing nothing about a problem is more aversive that doing
something even though the something does not change com-
plained of behaviors, perhaps, as Baer and his colleagues
(1987) suggest, this is better than doing nothing because there
is some social validity for some involved people. If doing some-
thing is better than doing nothing, then there are many people
who can do that something such as thousands of social workers
who work in schools, hospitals, child welfare departments, and
many other venues. If the doing something is accompanied by
a well-regarded explanation in the field such as attachment the-
ory, life span development, ecological theory, or trauma theory,
this may contribute to the view that something of value has been
done and something of value has resulted. This indeed is what
happens now. But different kinds of circumstances are involved
in related complaints. Situations include the following
1. Situations in which nothing could be done to change cir-
cumstances related to avoidable suffering. But how would
we know this without a contingency analysis by someone
who knows what they are doing? Would volunteers be as
effective as professionals (e.g., social workers)? Or does
offering services via a trained professional contribute to
the view that something useful has been done? Could we
use a computer program to attain hoped-for outcomes? For
example,