Two of the many questions on every caregiver's mind, at every support group I've ever facilitated, is "How can I motivate my husband/wife to do his/her exercises?", or "How can I get them to do what he/she is supposed to do?" Unfortunately, the only honest answer is "You can't make anyone do what they don't want to do!" We are all too familiar with the cliché, "You can lead a horse to water but you can't make him drink." I will attempt to offer some ideas to help you increase the possibility of getting the Parkinsonian to do what he/she has to do.

One of the basic tenets of Behavior Modification is that reinforcing positive behaviors can reduce or replace unwanted negative behaviors. Although the psychological jargon explains Behavior Modification in much more verbose and intellectual detail, my grandmother summed up behavior modification quite simply: "You get more with honey than you do with vinegar."

Ask yourself, what happens when your loved one doesn't do what they need to do. Let's look specifically at doing their exercises. Most caregivers tell me that first they remind the person about the importance of this activity; then they tell them, and soon after telling them, the volume increases until they are yelling. At this point, two things happen; a) as caregiver, you are frustrated and exhausted; and b) your loved one with Parkinson's is sulking, probably feeling guilty, ashamed, defeated, and certainly not exercising. The bottom line is you expended a lot of energy, getting unwanted results, and unfortunately, spending a lot of time paying attention to your loved one. And for the most part the person with the illness found at least one thing they can control in their mostly out of control life - you and your moods, and ultimately, whether or not they exercise. The fact that it is negative attention is of little consequence. Attention, whether negative or positive, still reinforces the negative behavior.

Since the negative attention acts as a reinforcer of that negative behavior (not exercising), it should come as no surprise that the negative behavior will continue as long as you continue to reinforce it. That is at least until you change the reinforcement pattern.

How would my grandmother use honey to deal with this problem? To begin with she would stop reinforcing the negative behavior, immediately, perhaps by refusing to pay attention to it. As difficult as it might be, try to ignore the behavior of not exercising by not reacting. What's the worst thing that could happen? After all they are already not exercising and you are probably feeling totally out of control. Well, guess what, you are not in control, never were and never will be.

Now for the hard part. You have to learn to reinforce the most simple of positive behaviors with lots of positive attention. A smile, hug, kiss or verbal praise for a simple positive action will reinforce that behavior and, like the bee to honey, they will come back for more.

The problem, as I am often told, is how do you find something positive to reinforce when the Parkinsonian does so very little, or as some say, nothing positive. When explored further, the caregiver will often realize that they can find things that can be reinforced, even if they appear to be insignificant or simple. Start with the most basic of things: did they get out of bed, get dressed, go to the bathroom, take their medication, eat properly, walk using their cane or walker, tell you Good Morning, I love you, etc.? Get the picture? Reinforce each positive behavior in a way that means something to the other person. I do suggest that there is one caution when attempting to use positive reinforcement. You might think that saying "You did great" is positive reinforcement, while the Parkinsonian might think a shoulder massage is reinforcement. What ultimately counts is what the person you are trying to "change" thinks. Take the time to think or even better ask, what the person you are trying to motivate or change thinks is an appropriate form of reinforcement.

There are other ways to help reinforce positive behaviors. Set small goals that lead to larger goals. For example, if "exercising" is the large goal, then 5 leg raises or 5 sit-ups would be a small goal. Small goals are easier to achieve and, let's face it, we all like to feel as if we have achieved our goals. Large goals might seem impossible to achieve; therefore too large a goal can intimidate someone from even trying, whereas smaller incremental goals will give the person a sense of accomplishment and give you, the reinforcer, a chance to use some of that "honey."

The caregiver can remind, cajole and encourage, but the motivation should never take the form of berating, yelling or shaming. If you define "motivate" as "making," the war will be lost. Sure, the battle can be won once or twice, but the reality is that, over the long run, you will lose the war.

Some might say, "this is ridiculous" or "why should I treat him like a child and give out 'kisses' when I only want him to do what he should, or must, do for himself?" The answer is simple. Because beneath it all you care, you really care about that person. Remember where we started. What was the result of all your yelling or negative attention? Why not try something new? After all, it just might work.

Besides, each time you make someone do something, resentment is sure to follow. It will be the accumulation of that resentment that will become the motivation to resist any of your later efforts to "motivate." All in all, with all my education and training, I know my grandmother was right. You can get more with honey than you can with vinegar.