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Question 85: I was one of the fortunate
500 that sat in the audience at Horton High School in Greenwich and
witnessed the magic that is you!! I am a....college prof and grief
therapist. I have a question regarding one of the techniques I was
taught as a graduate student re: behaviors that needed to be performed
in access of 30 times a day. The technique involved the paradox of
asking the client to increase the behaviors and hence they would be
unable to perform, say handwashing, at all. Can you share your understanding
of how this works? Or possibly you don't support this approach. It
was lovely to be in your presence. Regards, S.S., NS, Canada.
Evening
S.S.!
Your words
were most kind....WIth regards to your question, I've heard of this
technique too (called Massed Practice). To me it smacks of behavioural
modification ('if we make him hate the tic enough, he'll be motivated
to stop' -- kind of like the dad that forces the son to smoke the entire
pack of cigarettes in one sitting). In addition to being aversive for
the child, it is hypothesized that Massed Practice will fatigue the
muscles enough to reduce the tics. The former reasoning (b-mod) seems
to miss the point (i.e. it is not that TS'ers don't already have plenty
of justification for stopping) and the latter reasoning seems to 'throw
the baby out with the bathwater' (i.e. if I was so exhausted that I
couldn't tic, I can't imagine I would accomplish much else either).
My Child
Clinician's Handbook (Kronenberger & Meyer, 1996) tells me that
"despite early widespread use of this technique, outcome studies
question its effectiveness" (read: it doesn't work!). Based on
the neuropsychological learning model of tic formation I created for
my Ph.D. thesis (the Incidental Associations
Model), this technique is enormously stupid -- it would create that
many more connections between the tic movements and other day-to-day
movements (read: it could make tics that much worse).
