Behavioural social work with encopretic children, their families and the school

Social work intervention and the use of behaviour modification techniques is described in five cases of childhood encopresis, all boys. In two cases an operant model was adopted and the parents were asked to reinforce with praise and stars approximation to the goal (trying) as well as success (defaecation into the lavatory). The P.S.W. rewarded the children intermittently with praise and small gifts and supported and praised the mother for the efforts they were making. In the third case contingencies surrounding elimination were altered in order to bring about desensitization following an injury the child had suffered while sitting on the seat of the school lavatory. This had resulted in fearfulness over going to the toilet at school culminating in alternate soiling and constipation. In the remaining two cases self-monitoring was central to the treatment and training. The work was done within the context of a conventional casework relationship with the whole family which was warm and supportive in nature and directed towards problem solving in more than one area. Other members of the Child Guidance Team were involved with some of the children for the purpose of assessment, but the programmes were devised and carried out by the P.S.W. The author expresses the view that 'treatment through training' has shown better and quicker results than 'treating the underlying causes--not the symptom'. Several behavioural programmes currently in use are described and reasons given for the author's preference for the procedure adopted here.