In 1974 Goldiamond proposed a constructional approach to problematic behavior, arguing that intervention should focus on expanding adaptive repertoires instead of eliminating maladaptive ones. In this line, Bakker –de Pree and her group have developed Constructional Behavior Therapy. Its main feature is a focus on the client’s successful behavior, i.e. behavior which contributes to survival and self maintenance and results in a better personal state. By restoring and extending successful behavior, disordered and maladaptive behavior becomes superfluous and fades away.

Although the approach is well-founded on behavior analytic body of knowledge and described thoroughly in the Dutch language, it is not yet presented to the international scientific and clinical community, except from several presentations at international conferences.

The central issue in Constructional Behavior Therapy are the functional differences of adaptive behavior instead of its structural differentiation (topography). Approach, escape and active avoidance behavior result in a transition to a better state, but differ as to the perceived quality. Whereas approach produces a transition experienced as pleasure, escape contributes to well-being by liberation and relief. However, active avoidance produces the existentially most important state of safety.

Generally, this adaptive role of avoidance is not well discerned in mainstream behavior therapy, probably due to a major focus on maladaptive behavior. Further, active and passive avoidance are usually confused in the discourse. Whereas passive avoidance consists of refraining from behaving and is negatively reinforced, active avoidance is behavior which is positively reinforced.

Due to continual conditioning processes every individual acquires a personal repertoire of approach, escape and avoidance behavior. However, the opportunity to perform this repertoire successfully depends on the availability of suitable discriminative stimuli. So, the range of someone’s successful behavior is determined by both his reinforcement history (range of discriminative stimuli) and the characteristics of his current environment (provider of these discriminative stimuli).

To analyze successful behavior, constructional behavior therapy uses a special designed interview technique called contrast questioning by which the pattern of the client’s behavior controlling stimuli can be formulated. If we know the pattern of successful behavior, we are able to predict unsuccessful behavior. When there is a response restriction for the successful behavior, the individual will behave unsuccessfully and won’t be able to preserve a good state any longer.

In individuals suffering from mental disorders, such analysis of successful behavior reveals consistently particular regularities. The Theory of Dominant Active Avoidance (Bakker-de Pree, 1984, 1987) summarizes these behavioral data. Active avoidance prevails over other behavioral functions in a absolute manner. Moreover, this dominant active avoidance behavior is controlled by just one particular class of stimuli related to the threat of being socially expelled. We discovered several types of behavioral restriction, which all have in common that suitable discriminative stimuli are wanting or cannot be responded to successfully. Further, restriction of dominant active avoidance behavior results often in a extreme state of insecurity. If this ristriction continues, a state of disorder is bound to occur which manifests itself in the form of a mental disorder, e.g. anxiety or depression. The type of disorder varies from person to person, probably due to genetic differences, the conditioning history and subsequent secondary conditioning.

These clinical behavioral data throw a different light on the onset and persistence of mental disorders: disorders are primarily not the result of disorder provoking stimuli, but of the absence of essential behavior controlling (i.e. discriminative) stimuli.

Constructional Behavior Therapy prevents the occurrence of disorder by removing and preventing response restriction of adaptive active avoidance behavior. To achieve that, the individual’s range of discriminative stimuli controlling that successful behavior is expanded, a process of construction instead of elimination. The therapy is carried out according to a detailed protocol of ten interrelated, novel techniques, which -due to the focus on successful behavior- do not depend on the type of disorder. In a basic treatment the existing behavioral repertoire is restored and expanded and subsequently, symptoms fade away. However, active avoidance remains a critical element in the client’s functioning and a risk of relapse. In an extended treatment the pattern of successful behavior is diversified with approach and escape behavior. Although active avoidance remains a important and central element in the behavioral repertoire – as it probably does in all organisms- it loses its absolute dominance, providing behavioral flexibility and preventing disorder in case of behavioral restrictions.
Constructional Behavior Therapy has been applied in the Netherlands to hundreds of clients and a variety of mental disorders. Clinical observation shows great promise considering the predicting power of the functional analysis, the effects of the treatment and the satisfaction of the client. However, further research is needed to underpin the clinical findings. For now, Constructional Behavior Therapy.
Bart.E.E. Bruins  2007
References Bakker- de Pree, B.J. (1984). De rijkdom van de leertherapie in de constructionele gedragstherapie. Gedragstherapie, 3, 179 – 197. Bakker – de Pree, B.J. (1987). Constructionele gedragstherapie. Theoretische fundering en praktische realisering. Nijmegen: Dekker & Van de Vegt.