Shrink's Views

ramblings of an unknown psychiatrist

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Archive for June 13th, 2009

Moulding Behaviour: An Experience

Posted by Dheeraj Kattula on June 13, 2009

I have studied Behavioral Therapy in my college years. Practiced a couple of techniques in life, but I always preferred the genuine spontaneous response to a predetermined measured response. I succeeded in changing a person’s behavior using behavioral therapy techniques. I see her as not my subject but as my teacher.

Aastha Advent Bara

Aastha Advent Bara

Aastha, a two year old sweet kid, my next door neighbour, daughter of Biji didi (sister), one of our hospital’s nursing sisters, is the one I am talking about.

Aastha is a smart kid. By the age of one year she could indicate if she wanted to see (pass urine) or gugu (pass stools).

Then, her brother Aashish was born. She regressed. She passed urine in the corridors and walked over it and soiled the whole place. She also started throwing tantrums. All this was normal, but I thought it was desirable to change her to the same sweet kid that she was. At least I could try.

I must confess the first time I tried, it was not planned. It was rather a reaction to the irritation caused because of her behavior. I picked Aastha and told her to stop crying. She did not. I told her that I would put her in a bath-room if she did not stop. She cried louder. I put her in a bathroom and closed the door in such a manner (95%) that she could not close it from inside but I could always open it from out side.

I looked at the clock and mentally set the time as 0 min. 1 min later I opened the door and asked Aastha if she wanted to stop crying and come out and play. She increased her volume of cries. But she started playing with the water we store in the bucket. I regretted using this bathroom. It is theoretically unsound to allow substitute pleasures during a time-out.

Now that Aastha rejected my offer at min 1, I left her alone for two minutes and offered her to come and play if she stops crying at min 3.She refused. I gradually increased the duration after which I would make her the offer. She refused at min 8, min 15, min 30, and at min 50. Initially, she was increasing volume of her cries and later she refused to come out by being silent.

At 85 minutes, she reluctantly offered her hand and came out. I picked her in my arms and kissed her. I told her that she should not cry unnecessarily. I told her now that she has stopped crying and has become friends again, she deserves claps and kisses. Our many nursing sisters and other hospital staff kissed her. Aastha became very happy. She began clapping for herself. 🙂

So far so good. But, within a week or so, she threw a tantrum again. The treatment process followed. Only difference is that she came out in 30 minutes. Next time it happened she came out in 15, then 8, then 3, then 1.

After this whenever I saw her throw a tantrum, I picked her in a typical way as if I were to take her for her time out. She started to stop crying immediately and also began to smile!!!. She also clapped and showed as if she wanted kisses. She got her rewards but much later, that too after a lecture about why she should behave well etc.

Since then she requires only the mention of ‘Dhee Mamu’ (Dheeraj Uncle in short) to stop crying. One day Biji didi pulled Aastha by her forearm and inadvertently injured her elbow. This required a plaster of paris cast for few days. We can be pretty sure it would have been a painful state for Aastha.

Before they went to Orthopedic surgeon they showed her to me. Aastha was in tears, but she gave my typical smile. The smiled she gives when I picked her for her ‘time out’. I was shocked at how powerful this had become. I wonder what that smile meant. I felt it was ‘pick me and kiss me’, but I could well be ‘Mamu, please do not put me in the bathroom.’

I  realize that the ‘behavioral smile’ with a desire to avoid discomfort is different from the ’emotional smile’ of joy of being loved.

But whatever, Aastha is a lovely kid today. She does not throw tantrums. She has good bowel and bladder control. Bladder control was obtained by making her clean with a small mop. She loves to imitate house hold works. She loves the kisses she gets when the work is done. How good it is to have a child who loves rewards which you can provide easily! One could mould them to be wonderful.

Guess who gets on my nerves now…Aashish. Aastha’s one year old brother. I do not think Biji didi would allow me to treat her son the way I treated Aastha at age one. I tell her that she has got Maleomania. She just smiles.

Aashish Arul Bara

Aashish Arul Bara

The pitch his cry has precipitated a couple of headaches for me. AASHISH, Watch out…I am coming…

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P.S. ( for those to whom confidentiality and anonymity are important)

I have taken permission of Biji didi to publish these photographs and the story.

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Posted in behavioral therapy, children, emotion, parenting, psychiatry | 4 Comments »