Who’s conditioning who?
One thing that any therapist, pediatric or otherwise, will frequently come up against is that lovely word: behavior. Many have theorized about it and plenty think they know the best way to control, modify, or reduce it. Myriad techniques exist and on any given day in a pediatric setting, you can see several different approaches in action.
My question is, as a therapist, what level of responsibility do you have to carry over with behavioral strategies? If you have a student who refuses to participate or work during OT, what is the best approach for everyone involved?
Many would suggest a reward system; in other words, structured bribery. It usually works, because who wouldn't color or draw a shape or write a few sentences for some chips, candy, or some other type of prize? I know I would. However, coming from a psychologically based background, I know that this can lead to a child purposely refusing to do work just so that the incentive is offered to them. It's a solution in the moment, but it doesn't really solve anything in the long run because you are actually encouraging their non-productive behavior.
When confronted with a situation like this, I think of all the work that parents, teachers, other professionals, and children put in to implementing a behavioral program. Then I realize that we therapists can get stuck in a catch 22. We only see a child for a short period of time, maybe once or twice a week. In order to be able to bill (and possibly get paid ourselves), we need that child to work on the goals and objectives we've decided on. Because of this we may have to resort to strategies that sabotage a behavioral regime.
On the other side of the coin, many therapists routinely see their own recommendations ignored or incorrectly utilized. It's a frustrating element of our job. That is why I am hesitant to do the same thing to someone else, because that person put in just as much effort as I have.
Personally, I would rather sit there and wait out a child's poor behavior than reward it. However, the clock and the payment system are against me. I suppose I will have to find some kind of happy medium.
Any suggestions?