Book T of C
Chap T of C
This is the 2007 version. Click here for the 2017 chapter 13 table of contents.
How is behavioral contracting used in therapy?
What is self-monitoring, and how can it change behavior?
When behavior therapists work with long-term problems, individuals or relatives of individuals under treatment may be asked to sign a behavioral contract in which they agree to adhere to certain principles. Parents may be asked to negotiate a contract with a rebellious teenager, specifying freedoms and responsibilities. In a case history reported toward the end of Chapter 5 (from Tharp & Wetzel, 1969) a girl named Rena was helped by arranging for her father to play in the yard with her after she had a good day at school. This improved her behavior in school.
Self-modification can also be encouraged through behavioral contracting and through the procedure (briefly described in Chapter 5) called self-monitoring. For example, a person who wishes to diet may make a contract with a behavior therapist to keep track of all calories eaten during the day. The record-keeping activity forces attention to the behavior that the client wishes to change. Often this—combined with the social pressure of the "contract" with therapist—is enough to encourage self-directed change in clients.
Behavioral treatment of pain commonly involves a heavy dose of behavioral contracting. Patients with chronic pain often respond to a systematic approach that emphasizes exercise (starting slowly but adding more every day), reduction in complaining, gradual elimination of pain medication, and resumption of normal life activities. The client is led to act as if the pain does not exist, and oddly enough, this makes the pain gradually go away in many cases. The exact reason for the change is unknown, but clearly some sort of extinction or unlearning is involved.
Why is behavioral contracting helpful in behavioral treatment of pain?
This approach works, but it takes time and determination, and it can be tough on patients. They may have spent years with low levels of activity during which they relied on heavy doses of pain medications and helping activities from others. Now they are expected to wean themselves from all that help and gradually start acting as if they have no pain.
The pay-off is considerable: resumption of normal life activities and reduced perception of pain. Nevertheless, drop-out rates are high in such programs. Behavioral contracting helps by spelling out the challenges and asking ahead of time for an explicit commitment to persist despite difficulties.
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