Positive Reinforcement/Structured Feedback, Errorless Learning, and Co-Treatment

Nicole Chandonnet, MS, CCC-SLP

Therapy is both an art and a science

" ...that is, interventions/treatments can be

Artfully implemented science


Scientifically informed art”

Hineline, 2005

Therapy is both an art and a science
Therapy is a team effort
Therapy teaches skills
Positive Reinforcement/Structured Feedback
Sidman’s Five Pre-Requisites for Learning
Create a positive learning environment in therapy
Increasing the Probability of Success
Errorless Learning

Therapy is both an art and a science

The SCIENCE part The ART part

Therapy is a team effort

Therapy teaches skills

Positive Reinforcement/Structured Feedback

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Sidman’s Five Pre-Requisites for Learning

  1. Safe environment
  2. Praise without cueing
  3. Who delivers praise
  4. Praise for actions following cues
  5. Start training

Create a positive learning environment in therapy by

Increasing the Probability of Success

How to teach the skill(s) in question

  1. Be clear in your instructions and expectations

  2. Use a hierarchy of cues to teach the skill

  3. Min to Max = Ongoing assessment
    Max to Min = Errorless Learning

  4. Give the patient structured feedback so that shaping and learning can occur
  1. Positive general statement
  2. “You did a really great job in therapy today, we got a lot done.”
  3. Overall performance-specific feedback and praise
  4. “Nice job following directions.”
    “Good job checking all your work on those math problems.”
  5. Review errors in teaching skills
  6. “I know it’s really hard for you not to interrupt when you feel you have something important to say; we’ll have to work on that.”
  7. Describe how skills should be performed
  8. “Be sure to keep your feet straight when you’re walking.”
  9. Solicit questions from the patient
  10. Preview further training plans as needed
  11. Complete session with a positive statement

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Errorless Learning


But, don’t give your patient the answer. Show the patient how to get there instead.

B.F. Skinner discussed errorless learning in the 1930s

Sidman (2010):

Errorless learning: A teaching procedure designed by the instructor in such a way that the learner does not make mistakes. It is in contrast with trial and error learning, in which the learner attempts a task without benefit of feedback, whether the attempt was wrong or not.

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Co-treatment: When two or more therapists work together with a patient at the same time and approach learning and improvement from his/her own therapeutic perspective.

Co-Treatment has many advantages
  1. Patient can make good progress faster
  2. Positive reinforcement is more constant
  3. Reinforcement is distributed more evenly among therapists
  4. Patient gets practice at different skills at shorter intervals
Possibility of better outcomes
No increase in cost
More time to provide quality therapy to other patients
Not appropriate for every patient, but it can work effectively for the right patient

Skill Acquisition and Brain Injury

Many of these same techniques are used in treating persons with brain injury, especially when issues related to antecedent control need more detailed assessment, planning, and treatment.

Check out how Applied Behavior Analysis has changed the way in which persons with brain injury learn new ways to deal with old problems, and how a person can achieve returning to work, school, and community.


Hineline, P.N. (2005). The aesthetics of behavioral arrangements. The Behavior Analyst, 28, 15-28.

Parsons, M.B. & Reid, D.H. (1995). Training residential supervisors to provide feedback for maintaining staff teaching skills with people who have severe disabilities. Journal of Applied Behavior Analysis, 28, 317-322.

Sidman, M. (2010). Errorless learning and programmed instruction: The myth of the learning curve. European Journal of Behavior Analysis, 11, 167-180.

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