I have a (probably annoying) habit of pulling out my cell phone to show people that I meet pictures of my dog, Sonny. Seriously, if you’ve known me for more than five seconds, you have probably seen pictures of my pup. Since you’ve been reading for about five seconds now…
Sonny has had a rough life in some ways. He was diagnosed with osteochondritis (OCD) at six months old. OCD (not to be confused with obsessive compulsive disorder) is a very rare genetic condition that sometimes affects large breed dogs. Essentially, cartilage in the joints flakes off, creating friction in the joint that eventually causes chronic arthritis and lameness. As the years have progressed, so has Sonny’s arthritis, especially in the last few years. It was hard to see him struggle to get up the steps. Mandi and I decided that we should get a ramp to make it easier for Sonny to get into and out of the house. Despite being a tough dog, Sonny is not brave. He is deathly afraid of thunder and, as it turns out, ramps. I knew that I could have probably used my extensive training in behavioral principles (fun fact: besides being a psychologist, I also have a certificate in basic dog training), but for some reason, I never put in the time to train Sonny to use the ramp. Also, Sonny seemed to be able to continue using the steps with a little encouragement.
Very recently, Sonny woke Mandi up in the middle of the night. He came to her side of the bed panting heavily. Mandi noticed that Sonny had been sick inside the living room, so she let him out. Sonny came back inside and settled down to sleep for a while. We took him to the vet the next day as a precaution. The veterinarian examined him and initially didn’t note any cause for major concern. But before we knew it, Sonny was whisked away to the operating room at the vet for emergency surgery. Luckily, Sonny got through surgery just fine and has now made a full-recovery.
Sonny had an incision from the bottom of his chest all the way to his groin. He couldn’t use the steps to get outside, so I was trying to lift him up and down for the first few days. This was putting a lot of strain on his stitches, and I started to notice that his was leaking blood-tinged fluid from his wound. It was pretty clear that additional strain on the incision could slow down the healing process or even possibly cause the stitches to rip open.
It was at this point when feelings of despair and helplessness washed over me. I couldn’t keep trying to carry Sonny, and I knew that he was too afraid to use the ramp. As the tears ran down my face and visions of catastrophic injuries to my poor dog ran through my mind, I looked at him lying on the floor. I knew I had to do something to change the situation.
I remembered that I knew exactly how to solve this problem and the solution was obvious. Sonny needed to learn to use the ramp. In the exact same instant, I had a flood of very irrational and unhelpful thoughts: “He is too sick to learn anything,” “Ordinary behavioral principles won’t work for MY dog, especially since he just had surgery,” “I’ve never taught a dog who just had surgery to use a ramp, so I will probably just make things worse,” “It would be inhumane of me to put my dog in a situation that will create more stress.” These thoughts also seemed 100% true. The situation seemed even more hopeless.
I slumped in my chair and looked at Sonny. He needed my help, and there was no one else in that moment who could help him. I reminded myself that behavioral principles don’t care about my thoughts and feelings. They also don’t care that my dog just had surgery. Respondent and operant conditioning function independently from the drama we layer over the facts of our lives.
I took a deep breath, put the dog ramp on the floor of the living room, got some ground turkey from the refrigerator, and called Sonny over to me. Sonny was wagging his tail and sniffing the air. Good news: food was still reinforcing. I gave him a few morsels of ground turkey which Sonny gobbled up. I put a few pieces on the ramp and Sonny ate them quickly. Then the stakes were raised: Sonny only got more turkey when he put a paw on the ramp, then two paws, three paws, and then only when he was standing on the ramp. Once Sonny learned that being on the ramp was a cue for getting delicious turkey, he was ready for the next step. I used a bit of turkey to lure him toward and across the ramp. The first time he walked across the ramp on his own, he got a “jackpot” or basically a half handful of turkey. At this point I added a verbal cue (“Let’s go”) before using the food lure, and Sonny quickly learned that he would get more turkey if he walked across the ramp after hearing the verbal cue. Here is a picture of Sonny learning to like his ramp.
After a break, it was time to take the ramp outside. Sonny’s avoidance behavior re-emerged. The bits of ground turkey didn’t have enough reinforcement value to overcome the negative reinforcement of avoiding the ramp. I had two options: use a more potent reinforcing agent like peanut butter (Sonny will try to fly for peanut butter) or somehow reduce the negative stimulus functions of the ramp. I decided to hold off on the peanut butter for two reasons. First, Sonny had already had a decent amount of ground turkey and likely was feeling less hungry than before. Food, even super delicious peanut butter, already had a diminished reinforcement value. Second, I wanted to reserve the item with the highest reinforcement value until I really needed it.
I decided to experiment with modifications to the ramp to reduce its negative stimulus functions. Sonny seemed to be willing to put a few paws on the ramp before jumping off to the side when the ramp was slightly elevated off the ground. Sonny didn’t do this when the ramp was flat on the ground. In fact, he happily walked across it. I hypothesized that the lack of sides to the ramp was the issue. My friend Patrick came over, and we fashioned some makeshift walls for the ramp out of chicken wire and then broke out the ground turkey. In less than 15 minutes, Sonny went from tentatively following the food lure onto the ramp to walking up and down the ramp on his own.
Learning to use the ramp may have saved my dog’s life. When my irrational thoughts and powerful, negative emotions could not help my dog, behaviorism saved the day.
As I reflect back on this experience, I can’t help but think of the many times that I have been sitting across from a Service member or Veteran in distress and felt just as helpless as I did with my poor dog. Typically, these are situations when my client is reluctant to process painful emotion, when the urge to avoid is strong. This is especially true when working with trauma survivors. All my training and experience has taught me that moving into the pain with the client and helping them to face, rather than avoid, their suffering is the path to recovery. Yet, those irrational thoughts and powerful emotions tend to show up in these moments: “I can’t ask this Service member to talk about his trauma. He is already in too much pain,” “I know the research says that this stuff works, but it won’t work for MY client. His problems are too complex,” “Therapy should make people feel better and asking my client to talk about his problems will make him feel worse.” These are the critical moments in therapy when we have a very important decision to make. Do we do what we know has the best chance of being helpful in the long run, or do we choose to do something easier and “less risky?” In many ways, these moments will define who we are as clinicians and, in many cases, the trajectory of therapy for the client.
Unfortunately, it can be all too easy to give into the desire to avoid our own discomfort. We buy into our own emotional reasoning and rob our clients of the opportunity to discover their ability to be resilient. When we are staring suffering in the face, our clients need us to put aside our own fears. We cannot cater to the irrational thoughts and emotions that would have us take a “safer” and “more supportive” approach. We need to trust in our training and the principles that operate behind the drama. Our clients need us to help them to discover these principles in action so that they can begin to understand the way to recovery for themselves. Their suffering blinds them. We cannot let our suffering blind us.
I know that human beings are not the same as dogs. However, I think that, in many cases, the exact same principles that helped my dog to use his “ramp to recovery” can be of great service to human beings in distress. This is true even when we don’t believe it or when our emotions suggest otherwise.
So, the next time you are in the midst of suffering, when your client needs you to guide them into the storm, will you allow behaviorism to save the day?