Cooper and Wolowitz, or the tension between behavior analysis and strategic therapy

Is there a better way of dealing with human behavior?

 

If you are living in this century, you know The Big Bang Theory (if not, please get back to your time machine and prevent The Ninja Turtles from happening). If so, you are familiar with two of the main characters, Sheldon Cooper and Howard Wolowitz. Let me tell you why I think some of their characteristics are relevant for the field of psychology.

Cooper is a theoretical physicist. He knows everything -really, everything-, about the inner workings of the universe; he can solve complicated theorems and he comes up with new and exciting lines of research without sweating. At the same time, he is unable to use a screwdriver, or fix a simple electronic circuit. Wolowitz, on the other hand, is an engineer. He is not a doctor -and Cooper often belittles him for that-, and he is often left out when it comes to theory. However, he can manage the Mars rover equipment, he was an astronaut, and he is the one that frequently sets up the gadgets for the whole gang to play with.

One has the theory, the other one knows how to get things done.

My first training as a clinical psychologist was within the strategic therapy approach (I’m including here without distinctions the works of Watzlawick, Haley, DeShazer, etc.), and after a while I arrived to the behavior analysis wing, specifically the third wave therapies. And since then I had had the persistent feeling that those two approaches are best represented by the characters Cooper and Wolowitz (I know, both sides are going to hate me for this. Thats ok, I have no horse in this race, I just like to think). The BA wing -considered at large-, has an amazing and comprehensive knowledge about the nuances of behavior (human or animal). They have decades of research and they have developed useful principles for changing behaviors. But they often lack some sensitivity about the best way of delivering those principles in therapy. The ST wing, on the other side, has an interesting way of doing psychotherapy. It is fun to work with (by far, it’s the funniest approach to psychotherapy), and they are capable of helping people to change radically in an astoundingly short time. But the theory is sometimes confusing, is not helpful all the time, and the research is smaller.

This is my thesis:  if we are going to better help patients, if we are going to build a better society, it’s going to be helpful to listen each other.

Let me give you an example of what Im talking: Michelle Craske recently published a paper with some updates about how to best deliver exposure. One of the suggestions was to replace the fear reduction criteria with the expectancy violation criteria: instead of staying in the exposure until the fear subsides, stay in the exposure until the expectatives about harmful outcomes are violated. On the other hand Nardone and Watzlawick, more than a decade ago, were delivering treatment for agoraphobia with these instructions: «walk as far you can get, and when you reach the longest distance you can stand, turn around, wait a couple of seconds and then walk backwards a little further before going back» (I dont remember the reference, sorry). They are not using fear reduction as criteria, they are just pushing the limits of the patient’s expectations, just as Craske will suggest several years later.

If you are familiar with both acceptance and commitment therapy and strategic therapy, you know that things like «the control is the problem, not the solution», and the use of paradoxes, just to name a couple of them, are features shared by both approaches. Sure, they are refering to different things, to different theoretical backgrounds, but the similarities are there.

My best guess is that ST knows best how to deliver the principles that BA had developed and researched.

In 1991, the department of energy of the USA hired linguists, scientists, and anthropologists to solve a problem: how the tell to the future generations that a specific place has nuclear waste in it? The residues are radioactive for thousands of years, so you cannot just put a sign that says «Get the hell out of here». Languages change, and in 10000 years they may not know what «Danger», let alone the radiation symbol, means . And even if they understand some kind of physical sign, it’s very likely that they wont obey it (the pyramids’ curses were ineffective dissuading thieves). What was the proposed solution? Superstition. «Giant, jagged earthwork berms should surround the area. Dozens of granite message walls or kiosks, each 25 feet high, might present graphic images of human faces contorted with horror, terror, or pain(link

The point here is that sometimes, the lineal and logical solutions are not the best way to go when dealing with complex human behavior. You need to know the laws of behavior, at individual and cultural levels, and BA knows a lot about it, but you also need to think outside the box to change it -and ST knows a lot about that.

Some of the best episodes of The Big Bang Theory involves Cooper and Wolowitz working together. Maybe BA and ST working together can give us the same joy. At the very least, knowing that both wings have a quirky sense of humour, we can have the best psychology parties ever.