Shrink's Views

ramblings of an unknown psychiatrist

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…

—————————–

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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4 Responses to “Moulding Behaviour: An Experience”

  1. RPR said

    Nice story.
    18th-19th century children’s literature is littered with references to proto-behavior therapy.
    And even in this day and age,good parents just get the knack of it by trial and error.Good example of the use of social reinforcers, though.Most books do not describe that adequately. They talk more about material reinforcers.
    Good writing, though.

    Was the note about confidentiality because I asked you about it last time? 🙂

    @ RPR
    Thanks.
    You were not alone in asking about it:-)
    By the way,I liked the process of showing it to Biji didi and asking her if it is OK to publish it.She loved it,to see her kids appear on the web! 🙂

  2. Vivek Mathew said

    Heart always beats the mind in these things.
    Nice experience.
    You have an open mind.You don’t necessarily follow the book, you use instinct, intuition i guess. That is good in many scenarios.No two human beings are the same, So neither are their problems.
    So one has to adapt, that is something the books don’t teach us.

    I was taking care of a parkinson’s patient who was given a diagnosis elsewhere of being psychotic.She was started on Tab Clozapine and Risperidone. For two days i spent my entire evening talking to her most of the times just listening to her. It turns out that the psychotic symptoms were just the effects of parkinson’s.
    She turned just being depressed obviously due to her condition
    on listening to her, I had the gut feeling that she was depressed and not psychotic. Discussed with HOD and confirmed diagnosis. Got a big thank you from the patient
    I still keep in touch just to find out how she is doing.I felt good about what I’m doing.

    @Vivek
    Great buddy.Endless hours of listening…that is what makes us understand the disease and its context with relevance to patients.By doing the right thing you did something no body else could do for the patient.
    Psychosis and Parkinson’s difficult combination to treat.We know anti-psychotics worsen parkinson’s.Dopaminergic drugs used of Parkinson’s can cause Psychosis.And the possibility of Lewy Body Dementia,which can have both features.
    In addition to good diagnostic skills which make us pin a diagnosis,we need good level of empathy to motivate us to give that ‘extra’ to make a difference to a patient.
    All the best.

  3. Tiger said

    85 mts in a bathroom for a kid of 2 yrs is alike 2 years in solitary confinement for an adult. Either you were seriously angry or something is wrong. Don’t you think you put a fear psychosis in the kid which would taunt her all through her life whenever she goes into the bath room? Cmon. Why don’t you try staying in the bath room for 2 days, crying? This post made me sick. I pity Aastha, resent you and Biji. Sorry if you hate this.

    @Tiger
    Thanks Vamshi for bothering to comment.I respect you,whatever view you hold.So, I post your comment ‘untouched’.

    Let me tell you a couple of things.
    Aastha was never alone. In the sense,that she was always safe, right under my eye.I was not doing other things.I was keeping a watch.
    I was offering her to get out and enjoy what she liked.She was not coming herself,enjoying for a period and manipulatively crying for some.
    ‘Time out’ is an acceptable practice.I call it ‘time-out’-separation from pleasurable stimuli.It was not a punishment,where painful stimulus is given for ‘bad’ behaviour.
    In fact I do not like punishments.I tell parents to use other techniques instead.Indian parents somehow have not tapped into ‘time-out’ strategy.
    Let me tell you Aastha has more than 10 mamus in the campus and I happen to be her favorite mamu.Why? for consistent rewards that I give.She also knows I ll be consistent in ‘time-out’s.So she regulates her behavior properly.
    She is far from having any fear psychosis.Thanks for your concern for her.
    Let me tell you the previous commentators in this post are psychiatrists who did not have any problem with the principle or the technique.One of them teaching in a premier mental health institute in Bangalore.
    Your resentment,though understandable is not well placed.
    Thanks for visiting this blog.You are Welcome 🙂

  4. Nice experience. Even I have experienced that one mould a child the way one’s want. Of course, one needs persistence and patience!

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