Behavior contracts

[cara susanna]

Hey all,

I attended a CEU seminar on behavior contracts and now I'm really confused about what actually constitutes a behavior contract. I mean, I know what the definition of a behavior contract is, but how do we differentiate between a behavior contract and a therapy contract? If behavior contracts are ineffective, shouldn't that also implicate therapy contracts?

For instance, I'm thinking about the treatment contract in DBT.

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[Fan_of_Meehl]

Hey all,

I attended a CEU seminar on behavior contracts and now I'm really confused about what actually constitutes a behavior contract. I mean, I know what the definition of a behavior contract is, but how do we differentiate between a behavior contract and a therapy contract? If behavior contracts are ineffective, shouldn't that also implicate therapy contracts?

For instance, I'm thinking about the treatment contract in DBT.

All I know is that there is no contract with veterans that is, in practice, enforceable in the VA system.

And I learned long ago never to articulate any boundary (especially with the Cluster B types) that I was not 100000% READY, WILLING, and ABLE to enforce.

 

[Shiori]

That's fun! I just did an ethics training for this in TMS. I don't have an answer, but I came away thinking more about the motive. Am I trying to use the contract to motivate the patient to behave a certain way or am I trying to protect the fidelity of the programming? Ex: I will cancel all their remaining appointments if they no-show me twice because being minimally engaged can cause poorer outcomes and delay care to others. I am not using it to try to motivate the patient to come in regularly.

The other example mentioned was safety. If the person engages in an unsafe behavior like smoking in their residential room, the contract isn't generally an effective motivator of behavior change. There either needs to be a stronger motivator, or the person is removed as a matter of safety.

 

[smalltownpsych]

Not a big fan of using the word contract in treatment in general. Patient and I will discuss boundaries and expectations and goals in a collaborative way. It is an ongoing dialogue that we revisit at any time either of us feel we need to for a variety of reasons. In my mind it is like any other relationship and practicing this type of communication about these key topics is essential to healthy interpersonal interactions.

 

[Fan_of_Meehl]

Not a big fan of using the word contract in treatment in general. Patient and I will discuss boundaries and expectations and goals in a collaborative way. It is an ongoing dialogue that we revisit at any time either of us feel we need to for a variety of reasons. In my mind it is like any other relationship and practicing this type of communication about these key topics is essential to healthy interpersonal interactions.

'All of my self-assessment and self-change suggestions/options are completely, 100% voluntary...as is the as is the option of continuing your current beliefs and habits along with the predictable continuation of suffering that accompanies that pathway of non-change.'

something like that...but it's the gist of the philosophy

A metric buttload of strife, stress, burnout, gnashing of teeth, etc.,etc. is generated by 'well-meaning' VA policies/procedures to attempt to 'brute force' certain mental health outcomes. Brute force doesn't work well in mental health.

 

[R. Matey]

I've always thought that behavior contracts are contracts for the patient to agree to start or stop a certain set of behaviors. A therapy contract is an agreement between clinicians and patients on the goals and structure of psychotherapy (i.e., aren't all therapeutic relationships contractual in some form or another?). The problem that I could see with behavior contracts is that it could incentivize a patient to lie about their behavior in order to meet the perceived demands of the contract, which in turn could affect the quality of the therapeutic alliance. At least, I've never been a big fan for that reason.

 

[Sanman]

The difference between most behavior contracts and therapy contracts are that behavior contracts rarely have teeth. They can work, in my opinion, if there is a caregiver or parent involved. Therapy contracts have teeth, I am no longer seeing you if you do xyz. I don't recommend including thinks like homework because this just leads to excuses.