“Harry”: The use of physical restraint as a reinforcer, timeout from restraint, and fading restraint in treating a self-injurious man

Abstract

In the movie “Harry” (Research Press, 1980), Richard Foxx demonstrated the highly successful treatment of a young man's severe self-injury. This movie has had a dramatic and important impact on professional and lay audiences alike. Dr. Foxx was invited by AIDD's editorial board to present the data from Harry's initial treatment and, most importantly, a four year follow up on Harry's. progress. His article follows.

Harry, a self-injurious man who found restraint reinforcing was treated by a two-phase program. Phase I consisted of reinforcement with restraint for increasinglu longer periods of noninjury and timeout from restraint for self-injurious behavior (SIB). An ABAB reversal design was used to demonstrate the rapid reduction of SIB in Phase I. At the end of Phase I, Harry was displaying low levels of SIB, i.e., less than one episode per day, but had begun self-restraining by holding objects in his hands. Self-restraint was treated in Phase II by fading the size of the held objects to a point where he ceased holding them, An appropriate form of restraint, wearing eyeglasses, was substituted and Harry continues to wear them after four and a half years. A maintenance program was instituted following Phase II that consisted of token reinforcement for adaptive behavior, parent training, and an enriched program day that included vocational training and one-to-one interactions with a unit staff member. The four year follow-up results revealed that Harry's SIB is virtually non-existent and consists of symbolic taps to the nose or very light arm bites. The present study and work of others suggests that the therapeutic use of the reinforcing properties of restraint to treat self-injurious individuals appears to be an extremely effective way of; a) treating SIB, b) overcoming the iatrogenic effects of chronic restraint usage, and c) treating self-restrainers by substituting appropriate forms of restraint.