Reinforcements and expression

The first and easiest thing to do is examine the consequences for the behavior --- that is, what reinforcement contingencies are set up for this? The answer to that may easily point the way to change without the need for any 'second quessing' or the need to create complicated psychosocial explanations.

Remember, that Erickson demonstrated the removal of a symptom in several ways. Basically all of them had to do with changing the reinforment paradigm or consequences. To mention three: One was to have the symptom happen in a new context (however you wouldn't want this for a 5 year old nor for this messy problem); one had to do with a disruption of the symptom (also a poor choice for a 5 year old); one has to do with some alternate form of expression (this ~might~ work with a 5 year old okay) -- to try this, you would have to have a very good guess (based on some facts) of what she is inhibited from doing (here we assume the bed wetting is an expression the replaces some inhibited expression). Maybe this is asking to be held, maybe it is scare about school, maybe it aid thet mother or father's need to overprotect her as she goes off to school....etc. So, gether some info and make an informed judement about that. Then, ask her to, say, draw a picture of who/how she would like to _?__(be safe, be held, etc. - from you hypothesis)_?____ if she could tell someone in effectively instead of holding it in and wetting...and to draw this picture quickly just before wetting...or just before falling asleep, etc.

In this way, the act of expressing a need becomes linked to the act that expressed it inappropriately (it is not denied anymore). This is actually the Premack principle in behavior mod. Erickson didn't realize this, I think. Anyway, if it is an expression problem, this will alert the girl to the unexpressed behavior or idea.

But first, check the reinforcement.If the parent is involved in over-reacting to giving her lots of attention (due maybe to a sense of the girl becoming more independent) then some work with the parent to change roles and mature into this next developmental phase is essential. The girl does not do this in a vacuum unless she is having some severe muscle derterioration...which we know she doesn't have, right? So, it is part of the family communication some how.

Then you also must look at the relations with both parents and ask/answer, why does this parent reinforce this conduct with this attention (does it fill a need not being met in the partnership)?
So, in a nut shell, try to look at the larger picture, as you are doing by framing it as communicational, and don't merely 'stop' the symptom.

Replies:

Enuresis - a spontaneous behavioural change?, by Lindsay Smith, 11/21/01 Thanx, by M. Ameeri, M. D., 11/22/01

| Behavior OnLine Home Page | Disclaimer |

Copyright © 1996-2004 Behavior OnLine, Inc. All rights reserved.