Behavioral Therapy (ABA): Beyond Ethical

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This is an opinion piece which was inspired by a few sources recently, which I believe although anecdotal, has some insight from 10+ years of doing therapy, both behavior analytic and counseling. I was reading an article that came up online, one of those anti-ABA groups that search the internet selectively, for studies that support their views on this specific type of therapy. This article in specific was called “Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis”, and it seemed independently researched and not peer reviewed, whose findings were based off of subjective surveys, with questions worded negatively suggesting inherent bias. I am not here to review it. Suffice to say, I found it unconvincing, but it did raise questions. What if there were practitioners out there that were causing harm? Subscribing to a set of ethics is not too difficult, but if you don’t know why, you might lose sight of the principle of it being there; to do the right thing.

In Applied Behavior Analysis, there are rigorous codes of ethics. Codes that have to be studied and make up a large portion of the board examination, and beyond that, ever re-certification cycle requires hours of continuing education on the topic. However, I find, that it’s still hypothetically possible to meet all of that ethical rigor, and still fall short of doing a proper job of maintaining a positive and supportive relationship with clients. Nothing inherently dangerous, or harmful, per say, but still leave a neutral or negative view of the experience down the line. I don’t think any practitioner, BCBA or not, would want something like that if they could help it.

A famous humanist psychologist named Carl Rogers came up with one of the best precepts for therapy I’ve ever heard of. He called it ; Unconditional positive regard. It is exactly as it sounds; acceptance and respect from the clinician towards the client, no matter what. It doesn’t have to be continuous genuine joy, or merriment for every second of each session, but it does require the clinician to have one thing if they want to keep this therapeutic relationship going, and expect it to work well; positive regard for that individual no matter what happens in that session. Mainly, because all therapy, even ABA, is a relationship. It requires two people, or even more, and those interactions are in a sense what we model for our clients. It’s important that they know that they are respected, and the door will be open every time for them, unconditionally, and it has to be genuine.

There are situations that can cause some friction in any therapeutic relationship. Every single therapeutic field has it. With ABA it takes on a more difficult form, I think, especially when some of our clients do not have language, or any interest in forming a rapport, or even interest in any other person at all, therapist included. Sometimes clients can get aggressive; both verbally and physically, and sometimes therapists take on both kinds of scars. It’s not easy work. Sometimes that unconditional positive regard takes some effort. Behaviorally, you could call that all of the operants in your “positive regard” repertoire. Maybe it’s how you look at the client, or how you speak, or the tone you use, or even the direction of how you present your session. If it’s not aiming for the betterment of your client, then that’s the wrong direction.

Another concept from Carl Rogers is, the client has to want to change, or engage in therapy for it to work. B.F Skinner also talks about this type of engagement in his book “Science and Human Behavior”, but from a behavioral standpoint it all comes down to the same thing: positive reinforcement. There has to be something there that the client wants, for this change to take place. Don’t punish when you can teach instead. With non-verbal clients, sometimes they might not know why they are there, or understand what exactly is going on; we can’t say. It’s unspoken, and we can’t guess at it, but what we can do is make sure that their process is one that leads them towards that independent and socially significant lifestyle without harm, interpersonal or otherwise. Behavior change is hard. The targets we introduce, even if we aim them for exactly their level of proficiency, will challenge our clients, and we can not underestimate the effort in that challenge. We have to use positive reinforcement that works, and is strong enough to make the client “happy” to keep trying. That is ethical, but more than that, is the right thing to do. In ABA we are taught to avoid “default technologies”; unnecessary punitive procedures of disciplining, or appeals to authority. I can not imagine a condition where we would need to make a target where a client does something solely “because __ says so”. Would we accept that kind of contingency without questioning it? Of course not. As practitioners, we have to look beyond the short term and away from the older forms of discipline to help individuals go as far as they can in their lives. Long term strategies kept in mind while working on the short term, and while all that is going on… unconditional positive regard, positive reinforcement, respect for our clients and respect for what we are doing.

I believe this form of therapy is a force of good, and progress, in this world. It is evidence based, and supported tirelessly by decades of researchers, for the purpose of getting it right. When we use a therapeutic technique, we back it up. Every time. And always for the betterment of the client. That’s the point of removing the guesswork and ambiguity of the techniques; so we can shape it to work for that individual. We make it applied. Practitioners are trained endlessly on single subject designs for the purpose of avoiding the rut of comparing one person to another statistically. That puts the blinders on. The individual client comes to us for their progress, not in regard to their cohort. From that perspective, every individual does deserve that level of respect and regard for their future, and their life. As a practitioner, that’s a large responsibility, and it takes going beyond just ethics. It’s not just following a guideline. It takes doing the right thing, and knowing why.

Sources:

COOPER, JOHN O.. HERON, TIMOTHY E.. HEWARD, WILLIAM L. (2018). APPLIED BEHAVIOR ANALYSIS. S.l.: PEARSON

Rogers, Carl (1995). A Way of Being. Houghton Mifflin; 1 edition (1980)

Skinner, B. F. (1953). Science And Human Behavior. Riverside: Free Press.

Image Credits:

Clark Tibbs- unsplash.com

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