Search

Interview with Dr. Ennio Cipani


📷 Dr. Ennio Cipani

Journalist: Timur Begaliyev


Timur Begaliyev: Welcome to SciSection! My name is Timur Begaliyev, and I am the journalist for the SciSection radio show broadcasted on CFMU 93.3 FM radio station. We are here today with Dr. Ennio Cipani. Cipani is a psychologist who made house calls; he is a retired behavioral psychologist that gave training to parents and teachers in their homes. He compiled what he learned about human behavior into a book, which is taught in universities across the United States and Canada. The book — called Functional Behavioral Assessment, Diagnosis and Treatment — was ranked the number one in the ten best behavioral psychology books by wiki.ez.vid in 2018 and in 2020. Thank you Dr. Cipani for coming on today!

Dr. Ennio Cipani: Thank you! Let me just divulge just a minute. You mentioned a psychologist who makes house calls, and people are probably going “What is that?” When I came to California in 1981, they had a service called behavioral intervention service for people who have developmental disabilities and have significant problem behaviors that were hurting their mainstreaming efforts. In other words, they would be put in the community, and they would do behaviors that many times would put them back in an institution. This service said, “Well, let's take these behaviorally oriented psychologists and actually send them out to the referral.” It's called the in vivo model — psychologists would actually look at the problem on-site as opposed to having the psychologist come to your office and explain that. And the person we would deal with is the care provider, parent, adult et cetera. OK. So we would actually see firsthand what goes on when the problem would occur. Then, instead of providing didactic instruction in an office, the behavioural management personnel would say, “OK, we're going to do this when this problem occurs, and I'm actually going to be here helping you do that!” It's like on site coaching. I would be there and say, well, “Remember we talked about this? You don't want to do that. You want to do this.” So across a 45-minute session or an hour, we would get the adult to learn better how to respond — as in a prescription — to the behaviour or behaviors that the individual would perform. Unlike traditional psychologists, where everything is done in their office, we do things in real time, on site, in vivo. We get to see the battleground. If people are interested in reading about this, I have a book called Punishment on Trial, which is free! If you Google search that, “punishment on trial”, and put “Cipani” in the search box, you'll see a number of search entries and just click on one of the ones that gives the PDF for free.

Timur Begaliyev: I have personally read your book Functional, Behavioral Assessment, Diagnosis and Treatment, and your crazy case studies stood out to me. Can you tell us more about the case featured in the title of our interview?

Dr. Ennio Cipani: Somewhat interesting, I would imagine, to most people. We're going to talk about some girl running naked down the street, what is that about? This is actually not a case that I was involved with, but my coauthor Kevin Shock of my first two editions of the textbook you mentioned, was. He was the consultant, so he was called by a group home facility that his company was involved with in terms of providing behavioural consultation. And they said, “This adolescent female, at least twice a week, runs out of the house nude and we have to chase her down the street and try to get her back.” As you could imagine, it creates a significant management problem! In addition to the actual problem of trying to get her back in the home, the neighbors probably weren't thrilled to have an adolescent female running around nude. I believe, and I'm not sure of this, but I think the police were called once before in regard to this problem. So, Kevin was faced with a somewhat insurmountable problem of, you have to get this to stop. When people would look at that they would say, well, obviously she's doing it for attention. Either attention from the staff that have to chase her or attention from the neighbors, etc. But that didn't seem to be the case because Kevin asked them “Is she getting attention through common methods, like saying ‘Hey, I need some help?’ or ‘Can you come over here?’?” And the answer was yes, she does. OK, so this is a facsimile of what Kevin actually said. This is the astute part of what Kevin did — just brilliant in terms of his behavior analytic skills. He asked the staff, he said, “Well boy, that's, that's a pretty tough situation. Having a nude female, you know, out on the street. How do you bribe her back?” And he used the word bribe, but we would use the term “How do you get her back?” right now. He said, “How do you bribe her to come back?” And they said, we have to offer her a soda when she gets back in the house. You know, wouldn't that strike everybody as funny? She has to run out nude to get a soda? So here it is verbatim from my textbook: “Kevin says ‘What else does she do to get a soda?’ And the staff said, ‘Oh she's not allowed to have soda. She's on a restricted diet. She asked for sodas all the time and we tell her that she cannot have one and it is not on her diet plan.’ Kevin: ‘What does she do when she gets a soda?’” In other words, getting a soda is restricted, which would make its access limited — or actually zero in this case. The dietician wrote “No sodas,” right? So apparently asking for one is not going to work, and a whole bunch of other, more innocuous forms of behavior don't work. So, Kevin said, “Well, OK, let's make sure that that's the thing she wants,” so he asks, “Well what does she do when she gets a soda?” And the staff say “Oh, she guzzles it down, belches, and smiles.” Hence, the solution to this problem was to figure out what is driving this behaviour of running nude. And the answer was, it is the only way to get a soda for this girl!

And let me just sum this up, the behaviour makes sense to the behaver. That's what we live by! These behaviours, that we see, make sense.

Timur Begaliyev: So basically, she wanted access the soda, and she needed to get it through other people because she couldn't get it herself.

Dr. Ennio Cipani: Exactly! In my book, I know that you've read it, I have various functions that are designed in terms of a category system. And the classification of this type of behavior problem is socially mediated access. Socially mediated because she has to get the soda through somebody else. I'm sure that if she tried to go to the refrigerator, that would be blocked, right? “No, you can't have sodas.” So, in a sense, this behavior is what we call functional. Again, it makes sense to this adolescent female to do this behavior because it's the only one that will result in getting soda. Prior to the treatment, she was getting sodas two/three times a week because she'd run, and that's how they get her back. What was her level of stripping when she was on the treatment? What was the treatment plan? The treatment plan was Kevin went back to the dietitian and said, “Hey, can we give her one soda a week?” And probably the reason why soda was restricted was something like, well, she shouldn't have the sugar or some other business. Well, that applies to everybody, right? Why are you picking her out for this very onerous plan? So, the dietician agreed, “Yeah, we'll give her one can of soda a day.”

Well, how well did that work? Perfect. Zero streaking incidents from there on. Plan worked.

Timur Begaliyev: You also mentioned that there are other functions besides socially mediated access, such as direct access, direct escape and socially mediated escape. Can you tell us how you determine which one applies to the client or the patient?

Dr. Ennio Cipani: Sure, so the four functions — and let me break them down for the audience. listening — behaviors are maintained for the purpose of behavior, what we call the function. The function of behavior is either getting something or getting out of something. OK, so getting something I call access functions. That's the term I use in my textbook, and I try to teach that to students who read my textbook and other people who attend my workshops, etc. Let's call that an access function — it accesses something. Escape is the other one. What is escape? Well, escape is getting away from something. And obviously, you try to get away from something that you don't want to be next to or, I call it aversive. In an aversive situation, you want to escape. And it's relative to people, right? What's aversive to you may not be aversive to me. So that has two levels. You either get something or get out of something. Now, the other part of the classification system I have — Cipani Behavioral Classification System — is how the behavior works on the environment. If it goes through somebody, we call it socially mediated. So, in terms of access and escape functions, there's socially mediated access functions, which the soda example illustrated, and then socially mediated escape. In other words, you get out of something via the behaviour of somebody else. But there's another different level that acts on the physical environment, and that is that the behavioural chain, the things that you do, end immediately in the desired event or outcome. So, for example, if I wanted a soda, I could get one, you know, through somebody else. Or, if you don't live in this group home, what most of us do is get one. So that's called direct access. It directly gets something. And then the opposite of that is directly getting out of something. For example, if I wanted to get away from something that was happening in the house, I could either get somebody to terminate that event for me or I could terminate it myself by leaving. So there is four nice categories, and then all the things that we think of in terms of, “Is it attention, or is it access to a tangible reinforcer? Is it escape from an unpleasant circumstance? Is it because the instruction that somebody presented is aversive?” It all fits into those four categories. If you understand those four basic functions, you can pretty much solve behavior problems. I call that the Holy Grail of behavior — understanding those four functions.

Timur Begaliyev: OK, so once you classify someone’s behaviour as falling into one of those four functions, how do you determine what approach to do to alleviate that function?

Dr. Ennio Cipani: There's a number of ways that you can do that, and they range from not as efficient to very reliable. At the end of the very reliable, is an experimental methodology called functional analysis. That's where behaviour analytic personnel do tests. For example, if Kevin — Kevin didn't do this one, he was so smart at figuring it out that he didn't need to do that — but it might be if he said, “Well, we are not sure whether attention is the maintaining event or is it the thing that the individual wants?” Well, you could run two conditions. You could run the behaviour that gets attention and see what happens to the rate of behaviour when you do that. And then in the contrast condition, the behaviour doesn't result in attention. So, if it's attention that's driving the behaviour, what are you going to see? Well, you're going to see the behaviour go up when it gets attention, and behaviour goes down when it doesn't get attention. So that would be one way to test it out. And a guy named Dr. Brian Iwata that was at several universities in the United States — first at John Hopkins and then the University of Florida — developed a study that was published in 1982. I don't know when he started working on it in his lab, but he basically came up with an experimental methodology that now forms the corpus of the literature that is huge and vast in the field of behaviour analysis, demonstrating that behaviour is predictable. When you understand how to turn behaviour on and off, you can come up with “I know why that's happening.” Why? Well, because it gets attention. Oh, what do we do about it? Well, stop giving that attention and give something else attention. Because that's what the individual wants, at those particular times.

Timur Begaliyev: Is there any empirical support for your model?

Dr. Ennio Cipani: Yes, decades of research and behaviour analysis! The primary behavioural journals have a plethora of studies from the late 1980s to current. If you open up one of the issues, you'll see one — or several — articles that deal with this research methodology on how to do this. I might add that, in many cases and applied work, you don't have to go to that. You can do what Kevin Shock did, which is ask a number of questions and do some basic observation. One of the things I teach people is to watch what the behavior does in real real-timetime. For example, if the individual engages in oppositional behaviour, I'd actually want to go and see what happens when this individual is given an instruction or a command and the individual doesn't follow it. What happens after that? So, you actually get to see in real-time, oh first, he did this, and that didn't work because the adult kept saying “No, you need to clean up your room,” and then he did this, and that still didn't work. And then he finally did this, and the adult walked out of the room and said, “I'm done with you.” OK, so the last behaviour is the thing that worked, and if that happens over time, you see that that behavior becomes more prevalent when the individual is given a task or command or demand. So, there are several ways to do it.

Timur Begaliyev: Can you also define “oppositional behavior” for someone who might not know that was?

Dr. Ennio Cipani: Sure! Oppositional behavior is where the individual opposes some instruction or demand or command. It can be very mild in the sense of “I don't want to do that” or “Do I have to do that?" or whatever. But if the individual is heck bent on not doing that — and the simple “I don't care to do that” doesn't work — they engage in more severe oppositional behavior. It can go all the way from a mild form of verbal noncompliance to very severe forms. When it gets to that level, it's generally a problem that has evolved into something that entails medical necessity.

Timur Begaliyev: How is this model different from other models in psychology textbooks?

Dr. Ennio Cipani: Sure, well, in most models of psychology everybody is interested in why. “Why does this occur?” In other words, we try to explain behavior in terms of why. But most of the traditional approaches — the non-behavioral approaches — are well, this for example: Let us go back to the person who runs down the street naked. It might be that they explain it by a disorder. “Well, she has bipolar disorder” or “She has attention deficit disorder.” OK, the disorders don’t explain, I don't think very well, because it's kind of a circular argument. Well, why is she diagnosed with that one? “Because she does this behaviour and others.” And except for behavioural treatment, and medication maybe in some of the disorders, that doesn't really help toward edifying the nature of the contextual issues in the problem, but also kind of what to do about it. In b analysis, when you identify the function, you know what to do. This treatment is fairly straightforward, but it's also a trait. OK, she has the blank trait. “Why is he oppositional? Well, because he has that type of personality.” Again, to me, it's a circular issue. “Why does she have that? Well, because she does those behaviours.” It doesn't really — in my opinion — help at all. So that's the traditional approach. Again, the behavioral approach is find out what the circumstances surrounding this behaviour are. What happens before, and what happens after? That’s the key to figuring it out. It's the Holy Grail of behaviour. Find out what function it serves, and the answer will be fairly straightforward. Not that every case is easy, but when you eventually look at it in that theoretical vein, answers pop up.

Timur Begaliyev: A lot of our audience is in university or high school and if you could give one tip to a future parent of a problematic child, what would you say?

Dr. Ennio Cipani: Well, to boil it down to a simple thing, once you identify the function — and in some cases that you may need to do a lot of reading before you figure this out — but I would say that if you figure it out, you have to be consistent. Many people's understandings of consistency are not quite what's needed! It has to be 80%, 90%, or 100% consistent. Consistency makes all the difference in the world, once you figure out what to do.

Timur Begaliyev: Great! Thank you Dr. Cipani for coming on today! Is there anywhere that students can look to find out more about you?

Dr. Ennio Cipani: If they want to find out more information about the behavior analytic approach and my classification system — two things. Most universities have an ebook or a print form of the 2nd edition of my book, and some have the 3rd. So, if you have access to that, great. If you don't, there is an easier way to get at least the first chapter. I would recommend that — if you are new to the field of understanding behaviour from a behaviour analysis standpoint — read the first fifteen pages in the first chapter. If you Google search, Amazon has the first chapter that you can click on. Springerpub.com has it as a PDF, and there are other places, I'm sure, so they should have no trouble. And all of those are free. You have to buy the book, but maybe that's something you might ask the university library if they don't have a copy.

Timur Begaliyev: Thank you for taking the time to meet with me again, Dr. Cipani! And that's it for this week of SciSection, make sure to check our podcasts available on global platforms for our latest interviews!