The Role of Punishment in the In-Patient Treatment of Psychiatrically Disturbed Children

Abstract

The role of punishment in the psychiatric in-patient treatment of non-psychotic latency-age children with behaviour disorders is discussed. Punishment is defined as the removal of previously existing positive reinforcers or the administration of aversive stimuli. Ways in which appropriate social behaviour may be acquired are briefly considered. These include reinforcement of desirable responses, non-reinforcement of undesirable responses, reinforcement of incompatible responses and imitative learning. The reported effects of punishment on behaviour are reviewed and the psychological functions necessary before punishment can have the intended effects considered. For seriously disturbed children punishment is ineffective as a treatment technique. It reinforces pathological perceptions of self and adults even if it successfully suppresses behaviour. The frame of reference of the seriously disturbed child contraindicates the removal of positive reinforcers and verbal as well as physical aversive stimuli. Controls and punishments must be clearly distinguished. Controls continue only as long as the behaviour towards which they are directed. They do not include the deliberate establishment of an unpleasant state by the adult as a result of particular behaviour. Control techniques such as removal from a group may be necessary but when possible should be avoided in favour of techniques less likely to be misinterpreted. Avoidance of punishment in treatment makes even more important explicit expectations and provision of realistic controls. Natural laws may result in unpleasant experiences as an unavoidable result of certain behaviour. By definition such results can never be imposed by the adult. Treatment considerations may necessitate that the child be protected from the results of his actions. Avoidance of punishment requires a higher staff/child ratio, more mature and better trained staff. Sometimes children have previously been deterred from serious community acting out only by punishment. Should the therapeutic endeavours outlined not prevent such behaviour, treatment in a closed setting without punishment is indicated, not the use of punishment in an open centre.

The Plenitude and the Poverty Questions Arising from Twenty Years in Child Guidance Work

“…It reinforces pathologic per ceptions of self and adults even if it success fully suppresses behaviour". 15 Now, that is all I have time to give from the plenitude of ideas that inform our work-there are endless things to say about everything as you can see, but of course we must stop. You can see how close our work brings us to the family of man, and in closing this major section of my paper, I want to give tribute to the pro found clinical insights of Freud and his col leagues in the psycho-analytic movement, to the vital modifications made in the theories since first propounded which only a vibrant and truly alive body of thought could survive; tri bute to the thousands of leading thinkers in the ongoing studies in the human sciences from whom all that I have said is derived; and finally tribute of the most affectionate kind to my colleagues in Clinics, in England a few years and mostly in Sydney here over the past sixteen years, the psychiatrists, medical officers, psyMarch, 1969 AUSTRALIAN JOURNAL OF SOCIAL WORK chologists, social workers, and our administra tors, all of us working, often in a muddle, sometimes in self-importance, sometimes in enlightenment, but always some way seized by the enthralling interest of what we are engaged in.…”

The Therapeutic Paradox*

“…An essential role of treatment is to change pathological beliefs through interactions occurring with others. As far as possible, the behaviour should be dealt with in such a way as to avoid their further reinforcement (2).…”

Behavioral suppression of seriously disruptive behavior in psychotic and retarded patients: A review of punishment and its alternatives.

“…Few people, lay or professional, are without an opinion on whether punishment ought to be used to change behavior. Differing views on this question have generated an extensive literature on the theory and ethics of punishment of humans (e.g., Alderton, 1967;Buddenhagen, 1971;Church, 1963;Johnston, 1972;Maurer, 1974;Miller, 1967;Solomon, 1964). Although this debate continues, a substantial body of research has accumulated on the application of punishment for behavior modification.…”