Call the Doctor. I Think I’ve Been Poisoned!

I had a little outpatient procedure the other day. As I was leaving, still a little fuzzy, the discharge nurse gave me some papers including a little card in an envelope. She said, “This is a thank you note from all the staff who worked with you today.” I was surprised, and mumbled, “Well, I should be thanking them.”

I did think it a little odd to get a thank you note for undergoing a medical procedure! But when I got home I opened the envelope with that little surge of happy anticipation you can get with such things, even if it’s from a medical office and even though I suspected they had a reason beyond the simple goodness of their hearts for sending it. After opening it I first saw that five staff people had signed it by hand. How nice. Then I read the printed message. “Thank you for letting us serve you today. Please take the time to complete our survey.” There was a green sheet in the packet with questions about the service at the facility.

I felt slimed.

Thank you note. It was a poisoned cue in this story.

(This is a generic thank you note. I don’t have a picture of the actual note because I threw it away THAT DAY.)

I should have known better. I did sense that they wanted something from me when the nurse made a point of mentioning the note. I couldn’t imagine what they could want, though, and the suspicion slipped away. My cultural programming took over, and in spite of myself I had a little of that sense of anticipatory happiness that comes with an unexpected gift or even just a piece of pleasant mail.

I started thinking  about this in behavioral terms as I realized that they had squelched any desire on my part to be cooperative. That’s too bad since they were nice staff. Perhaps they needed the survey for some kind of accreditation. But I had a visceral negative response to this ham-handed attempt at manipulation.

I discussed the incident in the context of Dr. Susan Friedman’s course, Living and Learning with Animals, which I am currently taking.

I described my feeling of being tricked. I had been expecting a tiny happy feeling from being thanked. It might have reinforced going to that facility, or more probably opening the envelope of the card. I got an aversive instead. I was blindsided by pressure to perform a task, albeit simple, but in a way I really didn’t appreciate.

So instead a goodie potentially resulting in positive reinforcement, I got an icky application of negative reinforcement. Check out my post for a review of the processes of operant learning, a.k.a. “the quadrants.”

Susan Friedman pointed out that the thank you note was a poisoned cue. Whoa. Of course.

She was referring to a term coined by Karen Pryor that refers to a cue associated with both reinforcing and aversive consequences. Animals that experience this kind of mixed training are generally demotivated and often display stress. Nicole Murrey performed several experiments with poisoned cues for her master’s thesis research under the supervision of Jesus Rosales Ruiz at the University of North Texas. The behavior in the study was to come to the human on cue. The aversive seems comparatively mild  to us: it consisted of the dog being pulled into position via the leash when it failed to come voluntarily.

The dog learned one verbal cue for the behavior that was taught with positive reinforcement only. It learned a different verbal cue for the version that included the aversive. Adding the aversive completely changed the dog’s performance and demeanor in those training sessions.

Ms. Feisty being pulled via the leash. After she complies, the pressure will release, negatively reinforcing her movement in the handler’s chosen direction.


Being pulled where you don’t want to go isn’t fun for a real dog.

The above photo was graciously provided by Debbie Jacobs of She has a great blog here. Debbie’s life’s work is UNpoisoning things for dogs. I almost decided not to use the photo because it seemed a bit callous for me to compare my instant of squirming irritation with the experience of a dog being pulled by its neck. But these kinds of connections help me learn, and maybe they will you too.

Anyone who crosses over to training based on positive reinforcement notices the changes in the dog’s response to cues that are trained exclusively that way. It is writ large. And some of us actually retrain behaviors and change poisoned cues because of the negative associations.

For humans and some animals, the aversives involved with negative reinforcement can be completely non-physical. Negative reinforcement is present in social pressure, threats, nagging,  extraction of promises, guilt trips, even quotas and deadlines. All situations in which some kind of pressure is applied to get you to do something, at which point the pressure relents.

A thank you note is a cue for being thanked, and opening them has been taught to me with positive reinforcement. Every time I had opened one before this I had gotten a small bit of pleasure, or at the worst, a neutral experience. What I got this time instead was a mild aversive, and the surprise made it SUCK. This was a tiny incident in life, a blip on the screen. But I’ll bet it will be a while before I have unspoiled anticipation at opening a thank you note again.

Ironically, a straightforward request to fill out the survey would have been fine. But some marketing wannabe decided to pair it with the unexpected thank you note. I’d be interested to see whether they got more surveys back when they implemented that pairing. It didn’t work on me.

How about you? Have you ever gotten something slightly (or extremely) icky when you were expecting something nice? How did you feel about it?

Copyright 2012 Eileen Anderson

19 thoughts on “Call the Doctor. I Think I’ve Been Poisoned!

  1. Eileen, your thank you note experience was something like the first and only time I responded to one of those thrilling “YOU HAVE WON A NEW LAPTOP” notes on the internet. You open it, and you open what that one leads to, and start filling out forms, and then you realize that sooner or later you’re going to be asked to give some information you are quite sure you don’t want to give, and you back out like you’ve been stung.

    1. Yes, like being stung. That moment of realization. Made me realize–that’s one reason dog trainers who use bigtime negative reinforcement like ear pinches have to have the dog restrained. Because the other option of reaction to R- is an attempt to escape the whole scenario.

  2. Nice post, Eileen. Dr. Friedman is just awesome. I took her course last year and had many lightbulb moments! The telephone ringing can quickly become a poisoned cue if you are being hounded by a bill collector. What used to signal an opportunity to have a nice chat with someone becomes a cue that nastiness might ensue if you answer. You become willing to forgo a possible “nice” opportunity to avoid a possible “nasty” experience. It really only takes one unpleasant conversation with a bill collector to make you suspicious every time the phone rings, and to refuse to answer it.

    1. Yes! I’ve read several places that for survival reasons, aversives tend to be more potent than reinforcers. They can override, like you say. Email can be the same way if you are expecting an icky one. But at least in that situation you can usually tell which one it is and just read the other ones, smile. Thanks for posting!

  3. What comes up for me is feeling expectation of validation and being recognized/noticed (which is very powerful feeling of it’s about ME) to inscenerity and it’s really not about me, I”m just being manipulated to think that it is. One of our greatest desires is to be known, to be seen and to be validated just because we exist. I suspect it’s no different for our furry friends. It’s about just being “enough” without having to jump through any hoops to have to “earn” acceptance/recognition.

    1. Yes, this is a lovely point. And since we and they do sometimes have to comply to stuff we’d rather not do, it’s important to have the boundaries of when that is expected or not very clear. Certainly not mix it up with the expectation of just pure appreciation. Spot on, as always Marjorie.

  4. Good post, helped me understand a very big emotional reaction to what might look like a rather trivial event in my own past.

    When we were fairly new in the neighborhood, a nearby couple invited us to come for coffee one evening. We were happy, thinking they were reaching out in a friendly way to get to know us.

    When we got there, after a little chit chat, they ambushed us with a push to sign up for Amway (and then their field manager showed up at the door – surprise! three against two). We felt hurt, lied to, manipulated and disrespected. They didn’t really want to get to know us, just to use us for their business purposes; and they didn’t even have the honesty to tell us upfront what the real agenda of the evening was.

    The memory is still painful, and angering. Though, thank goodness, they moved away a number of years ago; that couple’s behavior instilled *huge* aversion to them and to the product they were pushing.

    1. I am so glad you shared your story. It doesn’t sound like a trivial experience to me at all. But I know what you mean about that feeling. I kept having doubts about my own post because I felt like it made me sound like a overly sensitive whining person. I mean, complaining about a thank you note? But small things can cause deep and longterm aversions, and that seems to resonate with a lot of us. Thanks so much for writing.

    2. I had a similar experience (but sales pitch for a different company). A few years later a neighbor wanted to get together with me, and what should have been interest and excitement that someone wanted to get to know me, was instead suspicion and guarding my emotions. It turned out that she really did just want to have a social hour (whew). Even though I don’t like feeling suspicious of invitations, I fear that it will continue.

      1. A friend reminded me that the sales pitch thing had happened to me too, and recently. A waitress we had always liked made a big deal about it that she was quitting working for the restaurant and going into business for herself. She went on and on about her new family business and how helpful and upstanding it was and invited us to a banquet and gave us some cards for “free” stuff that is part of a newish pyramid business. It left a bad, bad taste in my mouth (pun intended).The worst part was that it made me dislike her in retrospect. That was sad.

  5. Thank you notes are all about the person you are thanking. A survey is about their work and should be sent by mail or email after a few days. I would have done the survey just to tell them how tacky it was to add the survey in a welcome note.

    1. Great idea, Hazel! I actually considered sending back the survey, since I didn’t feel it was right to take it out on the people or even the facility for this klutzy move on someone’s part. But they failed big time in another way when trying to get behavior. They didn’t include a stamped envelope, or even an envelope at all! They didn’t make the desired behavior easy. So the survey is long gone….

  6. I think you should print this blog, put it inside a Thank You note, and send it to the facility where you got the outpatient procedure (and the disguised survey)!

  7. Eileen, I’ve just come across your blog and am enjoying your posts very much. This post made me think about how important it is that I not lie to my dog. (e.g., inviting her for a walk and then popping her into the car – she doesn’t like the car). As a first time dog owner I find your videos and post hugely informative. I’ve learned so much in the year and a half I’ve had my dog and am learning even more from the experiences you’ve been sharing.
    So, just a genuine note of thanks from a newbie dog owner — Thanks!

    1. Colleen, your post made my day. Thank you SO much for writing. I love knowing that I may be able to help a bit. That’s a very nice point about lying to your dog. It’s so easy to do that type of thing without thinking about it. Thanks again, and I hope you post some more.

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