Residential Program Treating Behavior Disorders and Developmental Disabilities

All aspects of the student's program, including any counseling that is provided to the student, are coordinated to produce the desired outcomes. A detailed explanation of JRC's policy on behavioral counseling is available below.

JRC’s treatment and education program is based on behavior modification and involves a careful and consistent use of rewards and decelerating consequences to build appropriate behaviors and to decrease inappropriate behaviors.

The counseling that JRC makes available to its students has been carefully designed to enhance, support and be coordinated with JRC’s behavior modification procedures. For example: (1) counseling is not provided automatically at regularly scheduled times, whether needed or not; instead, it is treated as a potential reward that the student can earn and as a service that the student can request at any time; (2) the contents of the counseling session are not kept totally private but may be shared with other members of the treatment team if that will enhance the effectiveness of the treatment/education program for that student; and (3) a variety of staff members participate in providing this counseling at both formal and informal interactions of varying lengths. Counseling at JRC is called behavioral counseling, to indicate that it is different from more traditional forms of psychotherapy. JRC’s clinicians observe and interact with their assigned students at least once every two weeks, are available as needed to provide behavioral counseling or to train other staff in providing behavioral counseling.

The purposes of behavioral counseling are: to give the students a chance to express any concerns or problems; to reinforce the importance of the students following their behavioral program; to encourage and teach the students to view their own behavior, and the behavior of others, with the conceptual tools of behavioral psychology; to teach the students how to use behavioral principles to improve their own behaviors through self-management; to teach the students to "generalize" their behavioral progress to their home and community settings; to review the students' treatment program to insure that that the students' academic, treatment and vocational programs are appropriate for their goals; and to consider ways to make the programs more effective.

Parents and agency officials are urged to make sure they are entirely comfortable with JRC’s use of behavioral counseling before placing a child at JRC. Parents who believe that a more traditional counseling approach is an essential feature of the program they are seeking for their son or daughter should consider enrolling their child in programs that provide such traditional counseling.

This paper explains what behavioral counseling consists of, what some of the problems are with more traditional forms of counseling (such as the fact that it is generally not effective with severe behavior disorders,) and how behavioral counseling deals certain issues normally associated with traditional counseling.

The primary vehicle that JRC relies on for accomplishing changes in the behaviors of its students and adult clients is the set of environmental “contingencies” (rewards and decelerating consequences, primarily) that are set up and carried out by the direct care staff on a day to day basis as part of the student’s individualized education and treatment program. These contingencies are in effect 24 hours per day across all settings, unlike the practice in many other settings. The primary focus of treatment at JRC involves teaching the students to decrease their problem behaviors, to learn new skills and to employ self-management.

At JRC behavioral counseling is available to each student when he/she needs it. The counseling is provided by the student’s clinician, by a social worker, by the student’s case manager, by his or her teacher, by a monitor or supervisor, by a member of the treatment office, or by all of these persons. Each JRC student is assigned to one of our clinicians and each clinician makes an effort to meet with his or her students at least once every two weeks either in a formal meeting or through an informal meeting in the classroom or residence.

Although JRC provides ample opportunities for counseling, JRC does not rely upon counseling as the primary means for changing the students’ behaviors. Our decision to rely primarily upon the day-to-day behavioral contingencies, rather than upon behavioral counseling, is based on basic behavioral principles as well as by research that indicates the following:

a) Contingency management is the most effective treatment for persons with developmental challenges; [1]

b) Traditional counseling is generally ineffective with children and adolescents; [2]

c) Group counseling or similar treatments may unintentionally produce increases in problem behaviors for certain adolescents; [3]

d) Intensive academic instruction has been found to be just as effective as traditional counseling as a treatment method;[4] and

e) Cognitive therapy (a non-traditional form of treatment in which an attempt is made to restructure the way that patients think about their problems) is generally not more effective than contingency management for adolescents.

1) Counseling as an earned reward.
At JRC the primary responsibility of the clinician and case manager is the design and monitoring of the student’s behavioral program, JRC encourages students to become more independent in recognizing and responding to contingencies that control their behavior. JRC does not encourage dependence on a certain type of relationship or interactions termed “therapy” or “counseling.”

Consequently, unless indicated for a particular student, we do not schedule regular counseling sessions on a fixed periodic schedule such once or twice a week. If the normal contingencies of the student’s behavioral program are working well, and if the student is behaving well, is happy, is learning to think behaviorally about his behaviors and his life, etc. there may be no particular need for the student to have regular individual or group counseling sessions with his or her clinician or case manager.

Although counseling sessions are not scheduled on a regular basis, there are several ways in which counseling can be initiated. A student can request, at any time, an opportunity to speak with his or her case manager or clinician if he/she has some problems. (There may be added requirements for obtaining the appointment, however, as described below.) In addition, the student’s clinician endeavors to observe and interacts with each of his/her students at least once every two weeks either in a formal meeting or in an informal interaction. During these informal interactions, the clinician may invite the student to his/her office for a more formal meeting.

2) Education in behavioral principles.
Part of JRC’s treatment strategy is to teach its students how to use behavioral principles to improve their own behaviors and interactions with others, to “generalize” their behavioral progress to their home and community settings, and to understand and deal with life as successfully as possible. To accomplish these goals, JRC arranges instruction in basic learning theory, encourages discussion of the application of behavioral principles to the student’s own history and current behaviors, and provides opportunities to set up and maintain behavioral self-management projects.

Some of this instruction takes place in the classroom, some takes place in the “chart-sharing” sessions, and some takes place in the course of meetings or discussions with the student’s case manager, teacher, social worker or clinician, or with a member of the monitoring or treatment office staff. The counseling that is provided at JRC is not limited to meetings that take place in a clinician’s office and does not last a standard amount of time, such as 50 minutes. Instead, counseling can take place in the classroom, in the corridor, in an office or in any other place. Duration, rather than being fixed, will be as long as needed. Although counseling is provided by various members of the treatment team, it is guided and approved by the student’s clinician.

3) Each counseling session is considered to be a potentially rewarding consequence.
From the student’s point of view, the counseling session may be a welcome break from his/her normal classroom routine and/or an opportunity to complain about his/her program to someone who, the student hopes, may be able to change it. For a young student it may also be an opportunity to spend time with an attentive and potentially rewarding professional. The student may also want to use the counseling session to express angry feelings.

Because the counseling session is a potentially valuable event from the student’s perspective, it is important that it not function as a reward for undesired behavior that the student has recently displayed. Instead the counseling meeting itself should be used as a reward for desired behaviors—for example, as a reward for the student’s having completed one or more contracts successfully. A cardinal rule, therefore, is that the counseling session should never be arranged or provided right after some problematic behavior that the student has recently engaged in.

Although this is an ideal that we should strive for, there are a few exceptions. After a major and serious problematic behaviors (e.g., a serious suicidal gesture), the clinician or case manager overseeing the student’s program will meet with the student soon after the incident and explore with the student the reasons that he/she engaged in the behavior and determine whether there is any need for a medical or psychiatric consult. However, in carrying out this meeting the clinician or case manager keeps in mind that the meeting itself may be rewarding the very problematic behavior that has just occurred and thus may contribute to prolonging the behavior problem by inadvertently rewarding it. Consequently, if such a meeting is held shortly after a problematic behavior occurs, the counselor will try to keep the meeting relatively brief and will try to make sure, whenever appropriate, that some decelerating consequences for the behavior (e.g. point fines, loss of privileges, etc.) are arranged (or are announced to the student before, at, or shortly after this conference). Hopefully the decelerating effects of these consequences will outweigh any potentially rewarding effects of the meeting itself.

4) Requirements for obtaining a counseling session.
Because the typical counseling session may function as a powerful, potentially rewarding consequence, the counselor is encouraged to use this fact to promote a few other goals that may advance the student’s program. For example, JRC policy is that a typical counseling session (other than one stimulated by some major inappropriate behavior such as is covered in 3 above) will not be arranged until the student, depending on his/her functioning level, has composed a written request for the meeting in the form of a legible business letter (written or typed on a computer if possible) that contains correct spelling and perfect grammar. Assistance from the student’s teacher, when necessary, is permitted.

Naturally, this may be too much to expect from some students. In those cases lesser standards are used commensurate with the student’s abilities. For most students, this requirement will help to teach appropriate means for requesting assistance and will improve the student’s writing skills. Many of our students are learning to write correctly spelled business letters in their academic work. A further benefit of imposing such a requirement is that it may decrease excessive demands by students to see their clinician or case manager. Of course, if there is some urgent reason for an immediate conference, the counselor can always relax or excuse this requirement.

JRC policy also is that the student must pay for the counseling session, using some of the points that he/she earns in the course of his/her program. The point cost for a counseling appointment should not be so high as to prevent the conference from occurring; however, it should be high enough to be of some cost. This is similar to real life, where it is often costly in terms of dollars to see any psychologist or counselor. Again, if there is some urgent reason for an immediate conference, this requirement can be relaxed or excused.

5) Purposes of the behavioral counseling session.
The purposes of a behavioral counseling meeting are different from those of a traditional counseling session. The purposes of a behavioral counseling session are these:

a) to give the student a chance to express any concerns or problems that he/she wishes to express;

b) to support, by statements that the counselor makes to the student, the current treatment program;

c) to encourage and teach the student to view his/her own behavior, as well as that of others, with the conceptual tools of behavioral psychology. This means using the counseling time to teach the student about the following principles:

i) Most of our behavior follows the basic three-term contingency (AntecedentàBehavioràConsequence) that is at the heart of a behavioral understanding of the actions of people;

ii) Outer behaviors (overt actions) appear to follow the same behavioral principles as do inner behaviors (thoughts, feelings, urge, etc.) Verbal behavior (speaking and thinking) appears to follow the same behavioral principles as nonverbal behavior.

iii) Emotions are combinations of reflex (involuntary) and operant (voluntary) behaviors generated by the emotional operation. In an emotion several behaviors change their probability at the same time. For example, when an individual is angry, his or her tendency to attack, hurt or curse the individual who is the source of anger may all increase in likelihood at the same time.

iv) All behaviors are lawfully determined by the individual’s genetic endowment and past contingencies. Although we all feel “free,” the best understanding is that our behavior is totally determined by the sets of rewards and decelerating consequence that we are exposed to throughout our lives. JRC students are encouraged to identify ways in which they can come into contact with contingencies that will support and encourage positive behaviors, on both short- and long-term schedules.

v) A student’s display of inappropriate behaviors is not evidence that the student has been “wrong” or “bad.” From a behavioral perspective, persons are neither “good” nor “bad.” Rather, their behaviors are conditioned (trained) to be one way or another by their environmental experiences. A student’s behaviors at any given point in time are the result of his/her genetic endowment as well as the contingencies (consequences) that have played upon his/her behavior throughout his or her life up to that point in time.

vi) The role of JRC is to arrange new consequences that will change the frequencies of various parts of the student’s repertoire so that that repertoire will be more successful in coping with the demands of life. Some of the major vehicles that JRC has designed for this purpose are

(3) the student’s self-management projects, in which he/she chooses his/her own behaviors to work on, records daily data and arranges consequences and other interventions to achieve desired behavioral targets;

(4) the group sharing and discussion of students’ self-management projects that takes place on a regular basis.

(5) the progressive levels of independence that students can gradually achieve as their behavior improves; and

(6) the supported and independent work opportunities that students can advance to as their behavior improves.

vii) The student is fortunate to have been placed at JRC. By virtue of this placement, the student now has a limited amount of time to take advantage of the trained staff and systems in place to bring about numerous and significant changes in his/her behaviors.

d) To consider how to make the student’s current program more effective; and

e) to understand the student’s long-term goals and to help insure that the student’s academic, treatment and vocational programs are appropriate for those goals.

6) The non-independent role of the behavioral counselor.
It is important to note that a JRC staff member who provides behavioral counseling to a JRC student does not occupy an “independent” role. Instead, the role of the counselor, and the role of any meetings he/she has with the student, is to help the treatment team carry out the student’s program. The counselor is in no sense “independent” of the JRC treatment program. Instead, the counselor is an important contributing part of that program that must be closely coordinated with it.

Please note that the expectation of privacy, that might be normal in out-patient counseling sessions, does not apply to a counseling session or other meeting between a student and his/her clinician, psychiatrist, social worker, etc. at JRC. Information that the counselor obtains during the meeting is reported to others at JRC whenever such communication can help to make the student’s program more effective. Parents of JRC students, and the student him/herself, where appropriate, sign a permission form at the time of the student’s admission, permitting this policy. Therefore the student does not have the right to expect that his/her communications with the counselor will be kept confidential internally at JRC.

7) Policy on modifying contingencies due to special pleading by students.
Because the counseling session is designed to support the current treatment plan, a JRC behavioral counselor will consider the matter very carefully before agreeing to modify the student’s current program, as a result of his/her conversation with the student. The student should not consider the counseling session to represent an opportunity to lobby for such changes. One of the objectives of the JRC treatment program is to teach the student to handle, without displaying major inappropriate behaviors (such as aggression), “unfair,” or even mistaken, directions from authority figures or arrangements of decelerative consequences. In the course of treatment at JRC, as in life itself, there will always be consequences arranged for the individual’s behaviors, and directions given to the student, that the student believes to be unfair, inaccurate or mistaken. If a student can handle and even accept these without losing his/her temper, he/she will be the stronger for it. For this reason, one part of our treatment program involves deliberately setting up unfair or mistaken directions or decelerative consequences for our students. If the students handle them successfully, they may sometimes be given a special reward for doing so. JRC students are informed of this practice and policy.

There is a further reason for this policy. If students are able to change the program requirements originally made by person A by appealing to person B, this may weaken the future effectiveness of person A’s statements to that student about the requirements of his program. When students are first admitted to JRC, they will naturally try to find out where, within JRC or outside JRC, they can most easily change aspects of their programs that they do not like. They will try to make these changes by talking to the teacher, the case manager, the clinician, their parents, etc. However, the best practice is to ensure that program requirements, once designed, are carried out exactly as originally set up, and that the students are not able to “get around” or change their program requirements by special appeals made to staff or parents.

It is natural for students to try to use counseling sessions to voice objections to some aspect of their current treatment program. A student will always be able to identify things that have contributed to the occurrence of his/her inappropriate behaviors, and to argue that in view of these factors, his/her current program requirements should be modified. An example is the student who argues that his/her inappropriate behavior was instigated by other students. Normally, however, the occurrence of such “instigation” will not be considered a reason for modifying program requirements previously made. The reason is that one of our goals is to teach students maintain appropriate behavior even in the presence of provocation and instigation.

Sometimes we may allow a contingency to be modified slightly in order to reward a student who has accepted some disappointment or decelerating consequence well, and who has handled the situation without displaying further inappropriate behaviors. In such situations, a penalty, previously imposed, might be slightly diminished, in order to reward this behavior of accepting the decelerating consequence gracefully. Although this is a permissible action, it is best if this does not occur as a result of a meeting with, or special pleading initiated by, the student during the course of a counseling session. Instead, it is best if the clinician or case manager or other supervisor simply notices (not at a time when the student is making a special pleading for a lessening of his/her consequences) that appropriate behavior has occurred and initiates the change (e.g., lessening of the consequence) in the student’s program. In other words, if such a change is made, it is not made as a result of a special pleading by the student. Otherwise, we may be inadvertently encouraging “special pleading” and excessive requests to see the clinician or case manager (because such actions have produced favorable changes in the student’s program in the past). For this reason, a clinician or other behavioral counselor may even impose a fine to control the behavior of excessive “special pleading.”

8) Objectives of Traditional Counseling.

Traditional counseling often has one or more of the following objectives, which are not necessarily the primary objectives of a behavioral counseling session.

a) Establishing rapport. This is always helpful, but is not the primary objective of behavioral counseling.

b) Encouraging the student to express his/her feelings.
A behaviorist does not subscribe to the “steam boiler” theory of behavior, in which the problems of the student’s life build up a kind of “pressure” inside of him or her which must be allowed to “escape” thought the safety valve of the “expression of one’s feelings.” From a behavioral perspective, we all have feelings, both pleasant and unpleasant. It is not certain, however, that the expression of those feelings necessarily changes the frequency of associated behaviors. There is also the danger that a therapist’s paying too close and sympathetic attention to a person’s expression of unpleasant and problematic feelings may serve to make such feelings occur more often, rather than less often, in the future due to the rewarding effects of the therapists’ attention. In other words, the individual may tend both to experience, and to express those unpleasant or problematic feelings more frequently in the future because of the rewarding aspects of the therapist’s interactions with him or her.

c) Encouraging the student obtain “insight” into the causes of one’s behaviors.
It not clear that obtaining such insight will change the future frequency of the behaviors in question. Insofar as such insight may be helpful, it would be best that such insight consist of an understanding of basic behavioral principles and how these can shape the form of behaviors, strengthen or weaken behaviors, bring behaviors under stimulus control, etc.

d) Attempting to provide a supportive audience for the student during a time of stress. We all appreciate the value of a supportive audience at times of major stress and it is desirable and humane to provide support at such times. However, this is not the major goal of behavioral counseling and there is always the danger that such support may inadvertently reward undesirable behaviors.

e) Attempting to “resolve” past “trauma”. From a behavioral point of view, there is good reason to be skeptical about the claim that getting a student to talk about past traumatic events is helpful to promoting more desirable behavior in the future. Indeed, attention to past negative events or behaviors could, in some cases, inadvertently reinforce undesirable responses. It may be more useful to identify and reinforce more positive alternative behaviors. These can be practiced and rewarded through the student’s academic program, self-management plan and treatment program.

f) Attempting to provide counseling treatment for a broadly defined “problem” (e.g., substance abuse, anger management, depression, or inappropriate habits or preferences).
Although certain rigorously defined traditional counseling approaches have sometimes been shown to result in improvements in certain behaviors, these improvements may be attributable to changes in behavior that can be achieved by other means. Traditional counseling approaches have not been shown more effective than behavioral contingency management.[5] JRC’s environmental controls permit more rigorous contingency management than is available in other community settings. Additionally, some counseling approaches that group together youth with problem behaviors may inadvertently worsen these problems.[6] JRC’s approach emphasizes the design of individual contingencies, positive modeling, and parental involvement to promote generalization and maintenance.

9) The role of one’s verbal behavior in affecting one’s nonverbal behaviors.

From a behavioral point of view, a student’s verbal behaviors (thinking, talking, writing, etc.) and nonverbal behaviors are two sets of behaviors that may or may not influence each other. A good example is the field of smoking. Many people will be able to state that smoking is extremely detrimental to one’s health, but this may be totally inadequate as a means to get them to stop smoking.

From a behavioral point of view persuading student to state, during a counseling session, what he will or will not do in the future may or may not affect whether he later engages in those behaviors. A behaviorist has a profound skepticism about the relation between saying that one will do something and actually doing it. The safest course is to assume that getting a student to show appropriate verbal behaviors will have absolutely no effect on his/her future nonverbal behaviors. This may not always be true, but it will be better to be surprised to find that the verbal behavior does have some effect on the nonverbal behavior, than to expect that the verbal behavior will necessarily affect the nonverbal behavior and then be disappointed when it does not.

How Cognitive Behavioral Modification is Incorporated into JRC's Treatment Program

Cognitive Behavioral Therapy (CBT) seeks to teach the individual how to think about his/her behaviors in a more productive way. At JRC we recognize that changing the way that students think about their behaviors may be quite helpful to furthering the accomplishment of our treatment goals for each student. We endeavor to do this in the following ways.

i) Changing the student’s thinking by changing his behaviors. If one dramatically reduces the frequency of a student’s problematic behaviors and if one imparts the academic, social and vocational skills that he/she needs to cope more successfully with life, it is inevitable that the students will, automatically, begin to think about his/her behaviors and life in a different and usually much improved way. In other words, desirable changes in thinking, sometimes are automatically accomplished by making changes in behaviors.

ii) Training provided during behavioral counseling sessions. During the clinician’s meeting with the student the clinician discusses both the student’s behaviors as well as the way that the student thinks about his/her behaviors. If the clinician uncovers the fact that the student displays inappropriate, self-defeating, illogical, nonbehavioral, or otherwise deficient methods of thinking about behaviors, the clinician seeks to correct and these examples of deficient thinking and to teach the student how to think about his/her behavior in more appropriate, behavioral ways.

iii) Self-management chart sharing sessions. At these sessions students discuss their own behaviors and their apparent reasons. A clinician is present as a group leader and tries to teach the students to analyze their own behaviors and those of others with the tools of behavioral psychology.

iv) Educational curriculum in behavioral psychology. One of JRC’s goals is to teach each student, whenever feasible, what the basic principles of behavioral psychology are and how to analyze all behavior with those concepts.

v) Specific practice of Cognitive Behavioral Therapy techniques. If, in the case of a particular student, the student’s clinician believes that certain specific Cognitive Behavioral Therapy techniques can help to make the student’s thought processes more rational and effective, these techniques may be incorporated into the student’s educational or behavioral counseling program.

How Behavioral Family Counseling is Incorporated into JRC's Treatment Program

It is the policy of JRC to offer behavioral counseling to the families of students placed at JRC.

Each student admitted to JRC is assigned a treatment team that typically includes a case manager, behavioral clinician and other professionals. In support of the student's treatment, this team will offer behavioral family counseling to family members or other caregivers in the student's home environment. The frequency, duration and means of interaction during behavioral family counseling may vary due to such factors as distance, participants' availability and preferences.

Behavioral family counseling includes verbal interactions and provision of information media. Verbal interactions may take place during formal face-to-face meetings, telephone consultations or informal meetings. JRC encourages contact between family members or other caregivers and treatment team members. These contacts may be arranged on a regular schedule, or an as-needed or ad-hoc basis. All meetings, interactions and provision of information should occur in support of promoting generalization of improved behavior for the student in treatment. JRC treatment teams, in collaboration with family members, will jointly determine what schedules and formats for behavioral family counseling are most appropriate.

Parents or principle caregivers of students placed in treatment at JRC will be offered opportunities to receive specific training in applying behavioral methods to better manage the student placed in treatment when the student is on home visits or with his/her parents. Behavioral family counseling may be appropriate for some family members before they participate in formal parent training. This might be particularly true when there are differences in perspectives, between family members and the JRC treatment team, concerning the causes of a student's behavior problems and the most appropriate treatment approaches.

There may be circumstances in which behavioral family counseling may include both the student in treatmnet and their family members. These occasions may be designed to resolve specific problems or disagreements, provide practice in appropriate social behavior or program implementation, or represent an opportunity for joint planning.

Behavioral family counseling is part of the services offered by JRC. Counseling contacts and progress will be documented in Parent-Agency contacts maintained in the JRC student database. These entries should identify the objectives of behavioral family counseling, interventions, progress achieved and plans for further intervention.

[1] Didden, R., Duker, P. C., & Korzilius, H., (1997). Meta-analytic study on treatment effectiveness for problem behaviors with individuals who have mental retardation. American Journal on Mental Retardation, 101, 387-399. Meta-analysis of 482 empirical treatment studies published between 1968 and 1994 showed that response-contingent procedures were consistently more effective than other procedures. Pharmacological procedures fell into the “minimal effectiveness” category.

[2] Weiss, B., Catron, T., Harris, V., & Phung, T. M., (1999). The effectiveness of traditional child psychotherapy. Journal of Counseling and Clinical Psychology, 67, 82-94. In the largest study of its kind, Weiss et al. reported on 160 children and adolescents and their families identified by school referral personnel as needing mental health services. The students were randomly assigned either to traditional child-oriented psychotherapy provided by seven therapists for up to two years or to a control group which received academic tutoring and no therapeutic counseling. Multiple, objective, repeated measures showed that psychotherapy yielded no statistically significant benefits.

[3] Dishion, T. J., McCord, J., & Poulin, F., (1999). When interventions harm: peer groups and problem behavior. American Psychologist, 54, 755-764. Two experimentally controlled interventions studies suggested that peer-group interventions increase adolescent problem behavior and negative outcomes. In traditional group counseling or similar treatments, high-risk adolescents may be socially reinforced for negative behaviors.

[4] Weiss, et al. (1999) [Ibid.].

[5] Weiss, et al. (1999) [Ibid.]

[6] Foxx, R. M. (1993) [Ibid.]