Box Turtle Bulletin

What Are Little Boys Made Of?

The original poker chips used in Kirk's treatment. (Photo courtesy of Maris Murphy)

Red and blue standard poker chips were used as ‘tokens’. The blue tokens, which came to serve as secondary positive reinforcers (Sr+), could be directly exchanged by Kraig for the ‘back-up reinforcers’ according to a ‘price list’ set by the mother (e.g., five blue tokens were required for a candy bar). The red tokens (Sr-) were discriminative for (a) a response-cost condition (i.e., red tokens were subtracted from accumulated blue tokens), (b) a timeout procedure (e.g., sitting isolated in a corner, being deprived of TV time), or (c) physical punishment by spanking from the father. Before introducing the token economy system to the feminine behaviors, it was judged ‘clinically safer’ to apply it initially to nongender behaviors in the home. …After the token reinforcement system had been successfully applied to the child’s nongender behaviors in the home, it was extended to gender-related behaviors. The mother introduced red tokens (Sr-) for one particular kind of feminine behavior for a period of weeks. She was told to verbalize the new contingency and then apply it on a continuous schedule. — Rekers, George A.; Lovaas, O. Ivar. “Behavioral treatment of deviant sex-role behaviors in a male child.” Journal of Applied Behavior Analysis 7, no. 2 (Summer 1974): 173-190.

Part 3: Red Chips, Blue Chips
Kirk had learned that playing with girls’ toys in the clinic was a bad thing to do, but that lesson didn’t extend to the home. So the Murphy home became the scene for the next phase of Kirk’s therapy with Kaytee set up as Kirk’s primary therapist.

“And so then they set me up with the poker chip program,” Kaytee said, referring to a system of punishments and rewards devised by Dr. Lovaas and adapted by Rekers. Mark and Maris would simply remember it as “the chips,” and they always spoke of it with dread. “Well I didn’t know,” their mother sighed. “I trusted these professionals to know what they were doing, you know?”

She explained how it worked: “When Kirk would do something bad, or play with the doll instead of the train or the truck or whatever, he would get a red poker chip. If he picked up a helicopter or an airplane or did a boy thing, then he would get a blue chip. At the end of the day, I would deduct the red from the blue. And then however many blue chips there were, they told me to give him an M&M for each for a reward. And then I had to keep this all written down.”

They also put Mark on the chips even though he wasn’t under treatment. “I think we put Mark on it so that Kirk wouldn’t feel intimidated,” she said. “It was to show Kirk that big brother was on them too.”

The chips were first introduced to the boys solely as a system for encouraging general good behavior. Slamming doors or getting into arguments earned them red chips; taking out the garbage or picking up their toys earned them blue chips. After several weeks under this system, the rules expanded as effeminate behaviors became a reason for earning red chips. A new girly behavior was added every couple of weeks, which meant that behavior which was tolerated the week before would become unacceptable the next. Incidentally, because these new rules were relevant only to Kirk, they didn’t apply to Mark.

Yet Mark today regards the chips as an extremely painful chapter in his life. When I first asked him to describe how they were used, he broke down and sobbed for several minutes, and it took him a long time before he could compose himself. When he finally gathered himself up again, he still couldn’t approach this topic directly. Instead, he eased himself into it by asking a question that he had obviously thought about for a very long time. “Did Rekers keep a log of the numbers of the chips? As in, were there so many chips at the end of the week?”

Kaytee did keep a log during the chips program, and the data gleaned from those logs were offered as proof that Rekers’s band new therapy had corrected Kirk’s effeminate behavior. It may be fair to say that Rekers built much of his career on the data she recorded. “That took a lot of my time,” she explained. “I had two other children and a husband to feed and laundry to do and … it wasn’t easy.” She sounded exhausted just remembering it. But the key question was this: did she log each incident before adding a red or blue chip to the pile? Or did she count up the chips at the end of the day and update the logs accordingly?

“I would mark it up at the end of the day after he went to bed,” she replied.

“If it (the study) was based on the numbers of chips,” Mark countered, “I screwed with those chips like you wouldn’t believe. I used to take some of his ‘whip it’ chips and put them in my pile.” As he said that, a note of pride crept in his voice. His reasons for doing this would prove to be the study’s fatal flaw: the terrible consequences of collecting too many red chips.

Mark took a deep breath and explained, “My goal was to take the beating for my brother.” Mark had long been accustomed to getting into trouble and being punished for it, and so he reasoned that he could take the beatings more easily than his younger brother. “I saw my brother’s whole back side bruised so badly one time, my dad should have gone to jail for it. Of course, he was somewhat carrying out instructions from the therapist. But my dad whipped my bare ass so many times before that, I figured I could take it. I mean that’s the way we got spanked. You dropped your pants, you bent over the bed, and he whipped your bottom with a belt.”

“My dad would come home, and every Friday we settled up with the chips. It was like ‘you go to your room; you go to your room’ and the whippings came on, it was over. And then we started with a clean slate.”

The red tokens (Sr-) used in our study were first discriminative for a response-cost condition (i.e., red tokens were subtracted from accumulated blue tokens) and then for a timeout procedure (e.g., sitting in a corner, losing TV time). But the undesirable nongender behavior did not cease with these less intrusive measures. Upon the parents’ suggestion, each red token was subsequently exchanged by one mild ‘swat’ from Kraig’s father. During the 10-month treatment, Kraig received a total of only two swats for nongender behaviors and four swats for gender behaviors. — Rekers, George A. “Atypical gender development and psychosocial adjustment.” Journal of Applied Behavior Analysis 10, no. 3 (Autumn 1977): 559-571.

A graph of Kirk's changing behavior based on the data Kaytee recorded in the logs. (Click to enlarge.)

To assure that our instructions were accurately carried out by the parents, a research assistant was sent to the home for 45-min sessions at least three times weekly for four months to observe the parent-child interaction, and to answer questions regarding the practical “day-today” operation of the token system. — Rekers, George A.; Lovaas, O. Ivar. “Behavioral treatment of deviant sex-role behaviors in a male child.” Journal of Applied Behavior Analysis 7, no. 2 (Summer 1974): 173-190.

…at this point, Craig was nine years old and I found, as the other psychologist had found, that he had a normal male sexual identity as well as a normal emotional, social and academic adjustment. The psychologist attributed this to the effects of my therapy, which included the parents’ learning skills in behavior management. These skills, in effect, extended the treatment program indefinitely on an informal basis in Craig’s own environment. — Rekers, George A. Shaping Your Child’s Sexual Identity (Grand Rapids, MI: Baker Book House, 1982): 138.

A follow-up psychological evaluation 26 months after termination of treatment revealed durability of the treatment effects with no resumption of cross-gender identification. He was found to be relatively less skilled in some desired masculine play behaviors, however. Subsequent to the initial report of these data, a research assistant made weekly visits to the home for several months to train Kraig and his father in playing ball together. — Rekers, George A. “Sexual problems: Behavior modification.” Chapter 17 in Benjamin B. Wolman, James Egan & Alan O. Ross (eds.) Handbook of Treatment of Mental Disorders in Childhood and Adolescence. (Englewood Cliffs, N.J.: Prentice-Hall, 1978): 268-296.

Before treatment, Kraig and his father did not enjoy each other’s company, but after treatment, Kraig became interested in weekend camp-outs and weekly ‘Indian Guide’ club meetings with his father. — Rekers, George A.; Lovaas, O. Ivar. “Behavioral treatment of deviant sex-role behaviors in a male child.” Journal of Applied Behavior Analysis 7, no. 2 (Summer 1974): 173-190.

I encouraged Craig’s father to take Craig and his brother on weekend camp-outs and to weekly “Indian Guide” club meeting. For the first time, Craig and his father learned to enjoy one another’s company. …I advised the father to spend an equal amount of time playing with both of his boys. This also helped Craig feel better about his relationship with his dad. … By feeling better about his relationship with his father, Craig began feeling better about his own masculinity. — Rekers, George A. Shaping your Child’s Sexual Identity (Grand Rapids, MI: Baker House Books, 1982): 137.

Whatever the therapeutic intent which may have motivated this system of punishment and reward, the chips nevertheless became objects of terror. “All I remember is first thing we did after coming home from school was to go and see how the chip pile was doing today,” said Mark. He grew to resent the chips on a very personal level. “I wondered, if I’m not in therapy, why am I participating in this program?” And if Mark resented it, imagine how Kirk felt. He was the reason the whole family was going through this turmoil.

Maris doesn’t really remember the chips per se, but she does remember the whippings. “After a belt evening, it was always very quiet,” she said. “We’d all be in our rooms, my Dad would drink and my mom would yell.” Maris remembers sneaking into Kirk’s room at night just so they could hug each other.

Whenever Rekers wrote about this portion of the therapy, he stressed the accuracy of Kaytee’s tally. That accuracy, Rekers assured his readers, was verified by research assistants who made numerous visits to the Murphy home several times a week for four months. Those visits were to train her on the program and to ensure that the logs were filled out correctly. So I asked her if anyone from UCLA had been at her home several times a week to train her or monitor the logs.

“Ha! I sure don’t remember that!” she laughed.

“You don’t remember that? Or are you saying it didn’t happen?” I asked, seeking clarification.

“That did not happen,” she insisted.

This is key, because the study’s data now rests on a set of logs that Kaytee kept to the best of her ability, but in the end was compromised by Mark’s moving Kirk’s red chips to his own pile.

Donna remembered seeing the poker chips on the shelf when she came to visit, but she didn’t know what they were for. She did know that the chips were very important to Kirk. “I remember Kirk having a complete meltdown because of the poker chips,” she said. “One time he begged his mom to take the poker chips away. I knew it was very traumatic for Kirk because he got spanked because of the chips.”

Donna remembered that her mother became concerned about Kirk. “My mom had a special bond with Kirk. They were both middle children, and she talked about how he got a raw deal and wanted Kirk go come live with us. I remember the discussion of her talking to them about Kirk living with us.” But nothing came of the suggestion.

After about ten months on the chips, the therapy officially came to an end. But according to Mark and Kaytee, the family continued to use the chips for some time afterward. (Rekers, writing in 1982 about “Craig,” confirmed the therapy’s unofficial continuation.⁴⁹) Kaytee explained, “I guess that’s what they expected me to do, to keep it up at home and not just drop it.”

But at some point (nobody remembers when), the chips finally came to an end. “All of a sudden, the chips just sat there for a long time on the shelf between the living room and the dining room,” Mark said. “They just sat there and it stopped.”

Rekers declared his experiment a success:

When we first saw him, the extent of his feminine identification was so profound … that it suggested irreversible neurological and biochemical determinants. At the 26-month follow-up he looked and acted like any other boy. People who view the videotaped recordings of him before and after treatment talk of him as “two different boys”.⁵⁰

Rekers wrote that there were occasional follow-up evaluations on Kirk. In one evaluation two years later, (we don’t know who performed it), Rekers decided that Kirk was deficient in “masculine play behaviors,” namely sports. “A research assistant made weekly visits to the home for several months to train Kraig and his father in playing ball together,” he wrote.⁵¹

“I don’t remember that,” Kaytee scoffed. “The only time I remember them being at our house was the day of Kirk’s birthday party when they shot the water guns.” Mark doesn’t remember anyone coming to the house either.

Rekers also wrote that Kirk became interested in weekend camping trips after treatment, but Kaytee strongly disputes this. “We used to all go camping,” she exclaimed, referring not just to her family but also the family of Kirk’s cousins. Kirk’s father, Rod, had a twin brother, Ron, and the two men’s families were exceptionally close. Kaytee said Ron’s wife was like a sister to her. “We started camping when Kirk was in a playpen,” she remembered. They often camped on Ventura Beach, and the boys looked forward to the outings. This was long before Kirk entered the program at UCLA. Kirk did join Indian Guides at Rekers’s urging, but that did very little to bring him closer to his father.

In 1974, George Rekers and his mentor, Ivar Lovaas, published the first publicly available account of “Kraig” in the Journal of Applied Behavior Analysis. They wrote, “There is no doubt that our treatment intervention produced a profound change in Kraig.”⁵² It’s hard to imagine a greater understatement than that.

Next: The Bitter Root

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