DRAFT APPLIED SOCIAL SCIENCE AND THE GENERAL TREATMENT STRATEGY Do not cite or quote W.A. Harris without permission. Introduction This paper proposes that the planning of social interventions could be facilitated by use of a generalized schema, known as the General Treatment Strategy (Talley 1975). The idea of a general treatment strategy is related to the idea of a formal theory. Formal theory, which drives theoretical science, is a universal, falsifiable statement which is used in an objective, value-free manner to enter into the explanation of empirical occurrences. Theoretical science accumulates knowledge by continually asking the question, "Why does this occurrence take place?" Cumulative knowledge, the product of theoretical science, is shared by a research community seeking the limits of empirical venues covered by formal theories. Analysis and rulemaking for the forms and procedures of theoretical science are addressed by the field, philosophy of science. Applied science employs the technologies and engineering used to put theoretical knowledge to practical use. Applied science is the face of the scientific enterprise most visible to the general public who are necessary for the support of scientific research. For most lay persons applied science is science, and the most interesting scientific question is "What is it good for?" The concept of values is relevant to applied science in the sense of ethical considerations, moreso than in the sense of objectivity. The identification of problems begins with a value position; someone must make the decision that a given situation should be changed. In bringing about change, however, the ethics of the method and the outcome must be considered. The venue addressed in applied science is usually confined to particular classes or particular instances of problems. A solution appropriate for adults may not be appropriate for children, or methods for training workers may miss the mark in the training of volunteers. Furthermore, much of the method and result of applied science is private or even privileged information, guarded by skilled practitioners or subject to rules of practitioner/client relationships. Finally, there is no overarching philosophical field organizing the forms and procedures of applied science. Aside from writings on organizational development, the codified works are, essentially, training manuals. Granted that these writings address such important fields as engineering, medicine, and psychoanalysis, but they are still training manuals. There is no known method to translate theoretical knowledge into applied knowledge. There is no known set of rules for methods to be used in addressing situations that need to be changed. There are many strategies for change in daily use and practitioners who swear by the use of these strategies, but there is no logical way to account for why they work or why something else would not work equally as well. For example, regarding most emotional disorders treated by counseling, the recovery rate is the same for those treated and for those left untreated regardless of the treatment method used. The foregoing assertions lead to a call for the construction of a philosophy of applied science, the foundation being a structure of statements analogous to the formal theory. According to Talley (1975), that structure might be called the General Treatment Strategy. The idea being propounded here is that applied science brings about change through the use of particular strategies of treatment for particular problematic situations. To the extent that practitioners can specify the parameters of problems amenable to treatment by a particular strategy, the level of generality of that strategy becomes known. Also, to the extent that practitioners are able to delineate the elements of a particular strategy, that strategy becomes replicable. The result of constructing the General Treatment Strategy should be an improvement in the training of practitioners and in the services delivered to clients. A guiding assumption in this work is that formal theory and theoretical research constitute appropriate models for the codification of applied science. A consideration of the elements of formal theory should guide the analysis of treatment strategies. Also, the knowledge generated by theoretical research is a likely source of information in the design of treatment strategies. Statement of the Problem The design of a treatment strategy begins with a clear statement of the exact nature of a problem. The problem statement should detail and specify the aspect of a grossly labelled problem which is to be treated. The existence of social problems is fairly simple to recognize. Social problems make us uneasy, they bring about anxiety in the form of desire for a change in the social situation. In order to be effective, however, the problem solver needs to target the crux of the problem. In doing so, the intervention becomes more manageable and more predicting of success. As the practitioner crafts an increasingly detailed description of the problem, it enables the identification of specific research studies which provide information on the incidence of the problem. Again, in identifying a problem needing change, it is necessary to be specific about the nature of the problem. One cannot assume that a term or label conveys the same meaning to all audiences. Thus, the term "learning disability" may connote dyslexia to one person and hyperactivity to another. "Sexual dysfunction" may indicate impotence or premature ejaculation, vaginismus or anorgasmia. Let us consider an example of a closely crafted statement of a problem. Example: abuse of children o "Abandonment of a child occurs when the child’s natural caretakers are for some reason unwilling or unable to care for the child, and have consequently abdicated this responsibility to an unwilling other person. Infants and children up to the age of five are often abandoned in institutional settings or other public places, or are left with a friend or relative. Older children are often perceived as runaways, though they may actually have been abandoned." Example: alcoholism o "Some alcoholics become dependent on the social contacts and social situations associated with their episodes of abuse, as well as with the use of the alcohol itself. This linked dependency is made worse when drinking buddies reject social contact with one who is reforming their drinking habits. Or, the social situations frequented by the reforming alcoholic are places in which alcohol consumption is the norm and nonconsumption is seen as deviant." There is a increased consciousness toward child abuse in human society. This is reflected in the increase in reporting of various types of incidents of abuse. Such reports are disseminated not only in the daily news, but also they have become the raw material of numerous talk shows and tabloid shows on television. Schoolchildren nowadays are instructed to be intolerant of abuse, and even to report abuse by parents to the authorities. Doctors have developed a heightened awareness of patterns of abuse observed in young patients. In the midst of normative change there is a perception that incidents of child abuse are on the increase in the present day, there is no way to tell if this perception results from increased sensitivity and increased reporting regarding the problem. This change in society frequently results in reports of mistaken accusation. Thus, we have become aware of concepts such as “false memory.” Or, we hear of strife happening in families because of pure accidents or self-inflicted injuries occurring to children. The term, child abuse, has come to cover a multitude of behaviors, including neglect, corporal punishment, sexual assault, and abandonment. Each of the behaviors of child abuse requires a separate and unique treatment plan, according to the view propounded here. One crucial feature of the proposed statement of a problem is that it focuses on a subset of the behaviors occurring in child abuse. This is important because the problem labelled "child abuse" may have several aspects which may require specific analysis and must be treated by separate strategies. For example, there are other types of child abuse as experienced by victims and perpetrators. Also, there are a set of problems which affect those who come into contact with abusers or their victims. A carefully crafted statement of the problem can suggest some potentially useful instances of theoretical research to be consulted for insightful conceptual and empirical information. The discarding of younger children in medical or social service institutions suggests the use of research on organizational structure or organizational culture. The ambiguity of whether an adolescent is a runaway or a throwaway requires qualitative insights to family dynamics and adolescent behavior. The caution in referring to theoretical research in the social sciences is the fact that few social theories are well developed. The use of concepts and findings from this literature requires a talent for estimation as much as a talent for locating references. However, this is a general caveat; given that there is no codification for the applied side, it should be expected that any given problem must be triangulated with several lines of research. Parenthetically, it should be noted that this type of analysis can lead to insights on problematic processes that may be in some way related to the focal problem. For example, the observation that child abuse is under fresh attack in today's society applies to other occurrences as well. That is, today's society has also developed a posture of approbation toward the use of tobacco, alcohol, unsafe sexual behavior, fatty foods, and even fur coats! It is not expected that a treatment for child abandonment would fit these other areas, but the analysis of the connections can prove useful for future insights. Another aspect of the statement of the problem involves the social context of the problem to be addressed in the analysis. The statement advanced here mentions the abandoning caretaker as well as the child and the context into which the child is abandoned. Decisions must be made on the extent to which an intervening treatment involves each of the elements delineated in the problem statement. Statement of the Solution The solution defined by a treatment strategy is determined only in part by the statement of the problem. It is necessary that the analysis of a proper solution touch upon the problem and issues beyond the problem. It cannot be assumed that the solution can be found by simply identifying a situation opposite to that which constitutes the problem. The statement of the solution must define a virtually ideal state of the situation in which the problem occurs, and that desired state must be practically feasible and morally acceptable. This is a point in the construction of a strategy at which values, in terms of moral and ethical issues, should reenter a scientific process of problemsolving. In stating the problem and its solution it is absolutely essential that ethical issues be considered. It may be necessary to create a role or procedure in the strategical process for the objective evaluation of moral and ethical issues. There are any number of possible solutions to a social problem. For example, let us consider our particular statement of a problem in child abuse: o "Abandonment of a child occurs when the child’s natural caretakers are for some reason unwilling or unable to care for the child, and have consequently abdicated this responsibility to an unwilling other person. Infants and children up to the age of five are often abandoned in institutional settings or other public places, or are left with a friend or relative. Older children are often perceived as runaways, though they may actually have been abandoned." Any of the following might be proposed as solutions for this stated problem: o Indentification by institutions of caretakers predisposed to abandonment of infants and the youngest children, and the provision of interpersonal and material supports to head off the possibility of abandonment; o Public information campaigns on alternatives to child abandonment; o Indentification by institutions of older children predisposed to being abandoned, and the provision of interpersonal and material supports to head off the possibility of abandonment. The feasibility of any of these solutions or others must be considered in light of the availability of fiscal and human resources required to implement them. Institutional monitoring of families with younger children would focus on children who are born out of wedlock, or who are sick or deformed, and especially if these conditions are combined with economic hardship in the home. In the case of older children the focus would be on children reported to be incorrigibly delinquent. In either case a record of past abuse would be a warning sign. The morality of any solution is determined by analysis of the effect of a solution on the client and the client's social world. It would be unacceptable if institutional monitoring resulted in de facto accusation of innocent parents, or if monitoring was the source of the parent’s first thoughts about abandonment. The practitioner must heed the consequences of attaining the defined ideal state as it will unfold when the problem is treated. The practitioner must consider the possibility that the ideal state defined by the solution may constitute a situation leading to the emergence of new and less acceptable problems. Or, it may be that the new situation is acceptable but the process of treatment involves undesirable side effects. Some examples of such consequences are: o When Mencius' disciple stated that the process of socialization was analogous to carving a bowl from an unformed block of wood, Mencius replied, "In order to carve a bowl from an unformed block of wood, you must do violence to the tree. Would you do violence to the individual in the process of socialization? If so, socialization will be thought to be a calamity." o The apocryphal quote of the Vietnam war was, "We had to destroy the village in order to save it." o Marriage partners have been known to address their marital problems by conceiving a baby. o With respect to the problem of alcohol consumption, Prohibition was implemented as a solution which had disastrous results. In crafting the statement of a solution, certain considerations must come into play: o What are the foreseeable consequences of the defined solution or of the steps necessary to achieve it? o Are these consequences themselves problematic? o Are these consequences more or less problematic than the original problematic situation? Finally, the statement of the solution simply describes a new state to be attained through treatment. The solution does not specify how the desired state is to be attained, that element of the treatment strategy is stated in the Procedures. The Procedures of Treatment While the statements of the problem and solution are in the form of descriptions, the statement of the procedure is in the form of prescriptions. It requires the statement of a set of instructions systematically directing the activities of the practitioner over the course of the treatment. One of the unsolved philosophical issues about this set of statements is that they have no sense of truth or falsity. Therefore it is not possible to test the appropriateness of such statements. The procedure is, of course, designed in light of the problem and its proposed solution. There must be some correspondence between the procedures of treatment, the presenting situation and the desired endpoint. Let us craft a rather farfetched procedure to fit one of our examples of solutions to treat our stated problem of child abandonment. This procedure involves some ideas about social environment and the psychophysiology of thirst. On the one hand, the practitioner may decide that the mental state or disposition of an individual is in part determined by the immediate social environment (Schacter and Singer, op. cit.). On the other hand, the practitioner may assume that an alcohol abuser is accustomed to consume relatively large amount of liquids during a period of abuse. If the client is presented with a social milieu similar to the one in which abuse has taken place, and if the client is persuaded to treat drinking behavior simply as a need for liquid replenishment, it may be assumed that the client can enjoy the form of alcohol indulgence without falling prey to the substance. This treatment would be appropriate for a client whose major complaint consists of a portion of our stated problem: o The social situations frequented by the reforming alcoholic are places in which alcohol consumption is the norm and nonconsumption is seen as deviant." In addition to counseling therapy, the steps involved in this treatment are: 1. Ascertain the details of the client's drinking behavior. What type of alcohol is consumed? What size glass is used? Is the social setting a bar? ...a house party? How is the client dressed for the drinking situation? What kind of music is played? Is there dancing? 2. Organize a laboratory setting replicating a social situation that conforms to the essential features of the client's drinking world. The difference between a bar and a rumpus room can be the difference between cocktail tables and sofas. In the interest of economy it is best to treat several clients at once in the simulated laboratory setting. 3. Convene groups of clients in their appropriate setting for a treatment session. Be sure that the appropriate music and glassware are present. Be sure that the clients are dressed in their "drinking attire." 4. Offer two kinds of drinks: a) iced water, or b) non- alcoholic drinks that appear to be alcoholic (e.g., Martinelli's sparkling cider). There are cautions in the drinks offered: i) Many drinkers have already tried and rejected non-alcoholic drinks that appear to be alcoholic. ii) Weight gain may result from the new drinks. The water option should be encouraged. iii) Some so-called non- alcoholic drinks contain small amounts of alcohol; this is a crucial fact if total abstinence is part of the sought solution (cf. Hess). This treatment has been reported to be used by some treatment centers. The only innovative aspect of the stated design is the assumption that drinking behavior may be related to individual patterns of thirst. Parent Conceptual Schemas A background of empirical observations and theoretical concepts from theoretical research and theoretical orientations can support the belief that a treatment strategy will result in the desired solution. In the social sciences applied work draws information and inspiration from three sources: formal theories, empirical findings, and theoretical orientations. The role of theoretical research and empirical observations is informational and directly supportive. The role of untested or unfalsifiable theories is inspirational, providing a supply of concepts and traditions grounded in the richness of social scientific discourse. The role of observation statements. The goal of many quantitative, theoretical researches in social science is the explanation or specification of occurrences in the social world which are disruptive to groups in society. An observation statement resulting from such research is, essentially, the statement of a social problem. The goal of many efforts in applied social science is the amelioration of occurrences in the social world which are disruptive to groups in society. An observation statement resulting from replicable research and describing a dysfunction in society is the starting point for the design of a clinical treatment strategy. Essentially, the observation statement is the critical point of convergence between empirical research and applied work. In order to overcome a problem in human affairs, some positive change must take place in an existing situation. Before a desired change can be effected, the origin of the problem must be clearly conceptualized. In that the statement of the problem is equivalent to an observation statement determinable through research, there is available an avenue to reach an explanation for the observation. Such an explanation establishes the antecedents of the observation. Therefore, within the statements explaining a problematic observation there is available information regarding the genesis of the problem. The observation statement or explanandum is determined by or logically derived from the explanans, i.e. the statements of scope and initial conditions and an abstract, universal knowledge claim. As long as the explanans does not change, the explanandum is not expected to change. On the other hand, if change were to occur in the antecedents of an observation statement describing a social problem, one would expect that change would likewise occur in the resulting observation and the problem. Essentially, an explanans which explains a research finding contains the critical elements which must be changed in order to bring about change in a finding which is also constitutes the statement of a social problem. The role of theoretical orientations. The social sciences are replete with theoretical world views for analysis of social systems and social behavior. As the bases for theoretical research, these theoretical entrenchments usually contend for possession of the received view, but in applied social science these conceptual traditions provide a smorgasbord of rich concepts to add to the design of treatment strategies. This is particularly true because a given treatment strategy will, typically, call upon a combination of informational and inspirational sources to diagnose and solve a given problem. A survey of theoretical orientations in reference to our stated problem of alcohol abuse will demonstrate how these conceptual structures are used. --Exchange theory: According to exchange theory or learning theory, all behavior is controlled by the reinforcing or punishing consequences associated with behavior. The stimulus and response relationships that drive behavior may be internal, though they are usually external. That is, the reinforcing event which follows a behavior could be an internal event, ssuch as a reduction of anxiety. Or, the immediate stimulus that prompts behavior couldalso be an internal event, such as the arousal of angry feelings. The model proposed here is of an input/output system. That is, various stimuli impinge upon the individual. As a reuslt of his or her learned associations, various behaviors are emitted. These are either reinforced or punished, depending on the immediate consequences of the behavior. These consequences then either strengthen the learned associations or weaken them, depending on whether the consequences were positive or negative to the individual. In light of this theory, alcoholism could be analyzed as a series of discrete behaviors elicited by certain stimuli (such as smoking a cigarette, greeting a friend at a party, or receiving a reprimand from a supervisor). The behaviors are reinforced by certain events which follow the drinking (such as cooling of the mouth and throat, social attention from being the life of the party, or forgetting the reprimand). Although not all of the examples of stimuli can immediately be identified as elements of our statement of the problem, it is possible to visualize them as aspects of the described situation. The "social contact" who elicits drinking behavior could be a friend or someone who arouses anxiety. Drinking and the occurrence of anxiety-provoking situations could become cyclical events. Parties are situations in which drinking is the norm, and smoking often occurs in such settings. As for smoking while alone, for many persons aloneness is associated with loneliness, an anxiety-provoking state. The point is that it is likely that unusual cycles of stimulus and reinforcement may be operating in cases of alcoholism. Analysis in light of this theory could suggest a treatment with 1) the identification and reduction of the eliciting stimuli, 2) the weakening of the association between these stimuli and the drinking behaviors, and 3) the neutralization or reversal of the positive consequences which reinforce the behavior. --The medical model: Nowadays it is popular to treat all dysfunctional behavior as the result of organic imbalance. Biochemical levels and viral damage have replaced mental states and social disorganization as the guiding concepts for social problems. The problematic behavior, a function of the underlying biological disorder, is expected to persist until the underlying disorder is corrected. In light of this theory, alcoholism would be seen simply as a predictable result of a physical or biological property. The treatment could involve a drug threapy combined with constant personal effort to overcome the organic dysfunction. A primary feature of this approach is that the individual drinker and the drinker's social contacts are absolved of any responsibility in the creation or maintainence of the alcoholic behavior. The locus of the problem is seen to be a bodily function that is not under conscious control. --Communication theory: In communication theory, all behavior, whether verbal or nonverbal, is seen as a communicative act within a definable social system. The significance of the behavior is twofold: 1) it expresses some idea or content, and 2) it implies a certain relation with others in the system. The relations implied by discrete behaviors link the actors into a social system. The network of linking relations define the actors, their attributes and positions in their social environment. The units of analysis extend from the interpersonal to the systemic, including the couple, the family, or the denizens of Cannery Row. The focus of analysis can be typical communication: "What are the rules which govern interaction?" Or, the focus can be extraordinary metacommunication: "What determines how and when rules are changed?" The rules of interaction are important because they regulate and standardize the behaviors through which actors define and express the "self." Members of the system usually enforce the rule rigidly and mercilessly. In light of communication theory, alcoholism is a set of behaviors enacted in relation to some social system. The significance of alcoholism is drinking behavior and the relationship with others that is evoked with the behavior. The behavior and the relationship are guided by the rules of the system. Talley cites a classic example: The drinking of the husband consistently pushed the wife into a nurturing, mothering posture because the husband became totally dependent when he drank. He would drink in her presence until he was incapacitated and "needed to be taken care of." The therapist directed that the husband was to drink all he wanted, but only if the wife was always one drink ahead of the husband. Since she was not accustomed to drinking, this strategy essentially resulted in the wife being totally drunk when the husband was barely getting his whistle wet. The result, of course, was to force him into caring for his wife, thereby shattering the communicative significance of his drinking behavior. The intervention was designed to interrupt the drinking behavior and allow a straightforward discussion of the various expectations and hopes that existed in the relationship. --Labelling theory: Social labelling theory distinguishes between the behavior of an individual and the label placed on that behavior by the culture. We react to another's behavior based on the way the behavior is defined by society, and not on the behavior itself. For example, there are behaviors which might be accepted from a white male as being "assertive." The very same behaviors might be seen as "aggressive" or "threatening" if the individual was a black male. Or, the same behaviors might be considered "bitchy" if the individual was a woman. The reaction to the behavior is not to the behavior itself, but to the varying cultural definitions or labels of the behavior as it is enacted by members of society with varying identities. Much of the research done under the labelling orientation studies the effect of having received a particular label. Many social labels control the access to specific social groups. That is, some friendship groups include all "rockers," while others exclude "headbangers." Some groups welcome only those who are "cool people," while others seek out those who appear "professional." In our alcoholism example, the label "recovering alcoholic" serves to exclude the client from some formerly friendly groups. Some social labels have far-reaching effects, resulting in reactions from a broad spectrum of society. Labels such as "sex- offender," "ex-con," "drug addict," or even "Vietnam vet" can have this effect. At times the effects of these labelling processes deny the individual access to mainstream society and force the formation and maintainence of a deviant subculture. The person being labelled derives the benefit or stigma of the label depending on its valence. Once defined as a "jock" or a "nerd," that label activates associations in the mind of the person being labelled. Those associations may have crucial effects on their self concept and behavior. In light of labelling theory, being labelled as an "alcoholic" can lead to ostracism when one's drinking buddies are reluctant to accept the same label. On the other hand, being labelled as an "alcoholic" can be different from having a drinking problem. It is conceivable that one could not actually have a drinking problem until they were labelled. That is, someone might be inappropriately labelled as an "alcoholic" and, because of the labelling process, become excluded from certain social groups. As a result, such an individual might be forced into a culturally defined position which fosters the development of a real drinking problem. The labelling orientation identifies two problem for the client: in the case of alcoholism, the client must 1) reduce drinking behavor, and 2) eliminate the social stigma that accompanies the label "alcoholic." Thus, one target of this approach would be the reeducation of society in its views on alcoholism, similar to the campaigns against intolerance or bigotry. Range of Application //NOTE: cultural considerations// Every general treatment strategy will have some range of situations or persons for which it is most appropriate. The design of the treatment strategy may require the consideration of other strategies having a range of application which seems inappropriate at first glance. In the organizational development situation, for example, Harry Levinson uses a psychoanalytic strategy in Organizational Diagnosis. The idea is to be sensitive to the range of application as an important element in the design of a strategy. The range has two components: 1) The parent theoretical and empirical work which informs the strategy contains some explicit or implicit statement of scope; this is the analog of range in theoretical science. The clue to an effective strategy may lie in extending the scope conditions attendant to the statement of the problem. For example, in working with small groups, the parent theory informing the strategy might apply only to groups which are differentiated on a single dimension, such as race. If we wanted to use this strategy in groups which met in face-to-face interaction, the dimensions of differentiation would be uncontrolled and might include sex, age, height, and education. Justifying the reasoning of the theory for use in the strategy would require some analysis of how it is informative outside its original scope. 2) The range should specify the requirements of the practitioner- client relationship. In order for change to occur, it may be necessary for certain ground rules to be agreed upon. For example, in Watzlawick's double bind approach to family counseling, the client must be 1) reluctant to break up the family, and 2) prevented from metacommunicating about the problem. In considering the range, criteria for inclusion or exclusion should be developed. These would constitute a set of measurement rules providing guidelines to decide whether the problem of a given person or situation fell within the range of the strategy. If we consider the alcoholism example, these guidelines would specify what was meant by the phrase, "dependent on social contacts associated with episodes of abuse." Someone who was relocating to a new city would not be an appropriate client for a strategy designed to treat resocialization in the face of hostile drinking buddies. Auxiliary Assumptions At two points in the development of a strategy, auxiliary assumptions are required. 1) It is necessary to make explicit the reasoning about the fit between the parent conceptual sources and the strategy. 2) The strategy exists as an abstract statement until it is to applied to some concrete situation. Because all situations contain their own idiosyncratic features, it is necessary to bridge the gap between the abstract strategy and the specific clinical intervention. In the second instance these assumptions are analogous to those in empirical research which attest to the operationalization of theoretical concepts. The assumptions linking the parent conceptual sources and the strategy would remain constant for a given strategy. However, the assumptions linking the abstract statement of the strategy to the specific intervention would change for every new situation encountered. Ideally, these auxiliary assumptions will have an empirical basis and, thus, be testable through empirical methods. Evaluation of Success or Failure With respect to the statement of the solution, criteria for the evaluation of results should be developed. These would constitute a set of measurement rules which would assess the attainment of the solution, as well as the maintainence of moral and ethical procedures and results. For example, if our solution for alcoholism were defined as "socially-assisted partial abstinence," then we would need measurement guidelines for ascertaining when the outcome included the proper "social assistance" and "partial abstinence." "Partial abstinence," for example, could mean "one drink per week" or "drunk no more than once a month." With the existence of such a set of clearly stated guidelines, the merits of the strategy become determinable. That is, these guidelines can clarify when the strategy has failed as opposed to when the client has failed.