Cultivating Care Within Problem Behavior While Serving People

For the last few months, my family has had to make some really tough medical decisions with and for a beloved family member.  Like many people, we are faced with caring for ourselves, our children, and loved ones at different points in their lives.  It’s made me take a deeper look into human behavior and what causes the challenging or problem behavior.   I’ve also considered the words we use to describe the behavior and maybe challenging or problem is something that is misaligned with what is happening.  With the current terminology, we are putting the responsibility of the behavior challenge on the person expressing how they feel.   If relationship wisdom is true, we should immediately consider what we are doing or not doing in relationship to the behavior that we see. 

As we have made these medical decisions, I found myself speaking with a medical provider who decided to describe my family member by terminology that included cooperative and compliant.    As the medical professional preceded to discuss this family member, not by who they are, their accolades, their education, their resources.  This person was described as uncooperative and in turn treated as a behavior, not as a person.  It took advocacy and direct communication for the people responsible for care during that time, to understand how they were to engage and variables to consider when we look at behavior.  This was not a dive in terminology, this was about setting events, history, and trauma. 

And like many of you, during these personal moments, my flow of daily responsibilities did not lessen.  In fact, seasonally, the stressors and tasks increased.  But, because I try to find the learning opportunity it led me to better empathize from the perspective of family.  If you know me, you fully understand that my approach to understanding problem behavior looks at the whole person and team including what are we as behavior analysts are doing to cause or further exacerbate the behavior.   I can tell you that colleagues do not wholly appreciate this approach.  But, we must look at the conceptual frames we operate in when working with people and supporting the emergence of behavior and skills that are socially viable.  Seeing people as problems is problematic.  Not seeing them and their behaviors (communicated or observable) is also problematic.

But why can’t behavior analysts do this…see these things? Because…

1. We are asking people who are burdened by work to shift all the while carrying the cognitive load of work.   When one is constantly asking to BE SEEN  and ignored, it is difficult for people who carry the cognitive load of the work to see others and have the capacity to act with consistent care.  There is old adage in that I cannot consider you fully unless I fully understand how to see myself.
2. Observing behavior of disengagement in others would mean that we have a pulse on our own disengagement and burnout indicators.  When we know and embrace our own indicators, stress, and trauma…we are better able to allow space for others  to occupy that same human space.
3. A deep dive into the reality that self-injurious behavior happens to us too is the real work.  When we FBA ourselves, we then understand that there are functional relationships between organizational culture and our own verbal behavior (apologizing to make other’s comfortable), private events (i.e. guilt).  This is self-harm.  When we look at our client population, we view their SIB as their behavior…not necessarily all the factors in relationship with that behavior.  Arriving at space of self-introspection is connected to what we honor in the clients we serve.
4. Behavior is truth.  It is the truth of what the person thinks and feels.  And the truth is hard to handle.  Truth requires introspection.  Truth requires planning for next steps.  Truth will continue to be in your face until it is heard and listened to.  Problem behavior may truthfully indicate I don’t like it here or I don’t like you.  Consider that truth is really a question requiring an answer of behavior and systems change.

When children communicate their truth often well articulated through words or the physical manifestations of aggression or self-injurious behavior, teams must take a step back and first ask a few questions:

1. What are we missing?  Did we miss a nonverbal indicator?  Did we miss a groan?
2. What are we doing?  Are we invading space, are we not honoring that children may simply want their loved caregivers?  Are we dishonoring the boundary the child is communicating? Is the preference for a hug being substituted for a less preferred reinforcer? 
3. Are we considering this person?
4. What part of human dignity is being removed from this interaction with the child?

I remember telling a friend that I was looking for a person to not ‘watch’ my children but to ‘care’ for them in my absence.  Whether verbal or not yet verbal, people feel the difference.  When they are in treatment, watching them is different than caring for them.  People work well when they have connections, adults and children alike. Extraordinary humans placed in conditions less than stellar with no acknowledgement, advocacy often exist with these characteristics because of personal cultivation.  They carry with them a level of human care and dignity despite  their conditions.  When these boundaries are defaced, the person or family makes decisions to preserve their own human dignity.

The responsibility lies not with the therapy team, but organizations as well.  It is a simple domino effect…adults who feel cared for do a better job of caring for their patients.  Adults who feel watched with majorly communicated metrics and task lists, become mechanical with smiles and flowery voices…but a watch culture is manifested in peer to peer relationships and in client services.

And when human dignity is removed…

We land in this place of describing people in categories like Kiddo.

 We land in this place of describing people by behavior. 

We land in this place of giving frothy statements to people that include “it was a good day” with a smile to a parent whose child who smears feces. 

We land in this place of not telling the truth at any level often selling disorganization and culture wrongs as a business organization that thrives.

When we remove the name of our patient, we no longer see the child as a 4 year old.  Four year old’s have names.  They are not kiddos.  They are children who miss their loved ones with personalities regardless of verbal ability.  They are babies. 

So in the words of an old friend, “for the sake of human dignity…have some…get some…and show up with it”.

Until next time.

~Landria Seals Green, MA., CCC-SLP/BCBA