A Dad’s Role in ABA Therapy

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Don’t let the title fool you into thinking about this as a division. A father’s role in therapy is the same as a mother’s role in therapy, or any guardian in therapy. Responsibility, respect, love, and contribution. That should be a given. But sometimes it’s not always treated that way.

A recent intake for a client stuck with me. In this intake we were discussing prior ABA services for the child, and how parent training was done, how programs were generalized, and what seemed to fit best with their prior therapy experiences. It’s good to get an idea of these things. Parent participation is important in therapy. Incalculably important. In this particular one, the father mentioned their prior BCBA tended to discard his suggestions on targets, or socially relevant behavior goals. This caused a second or two of an awkward pause where the mother jumped in with a humorous aside about how the BCBA got along much better with her. The thing is, you could see that the way the professional handled that situation limited the father’s future enthusiasm to engage with the process. Some people could often mistake that as the “Dad being distant” cliche, and everything continues as these expectations play out. The problem is, we had a parent interested in a process, who had a voice, and that voice was silenced (ignored) and guided to a false consensus.

There are sometimes these unspoken things, or expectations, in parent roles. Some are traditional things that stick around, some are just artifacts of a bygone era that do more harm than good. Rooting those kinds of things out and making more functional alternatives tend to help the whole process along, relationship wise, responsibility wise, and makes people all together wiser about how they’re behaving and what the expectations are for how therapy will work. Parenting is sometimes rule governed after all. In therapy, professionals, like BCBAs, can sometimes make unspoken rules with unintended consequences. Inferences here. Ignoring something there. The feeling I was getting from this situation above was that there was not an equal input in the last experience with ABA therapy. So, with a little back-stepping to basics, I wrote down all the suggestions both parents had for goals, and funny thing was, Dad said more, and the Mom was surprised. We all learned something. It sounds like a small thing, but imagine what a trend like this could have been long term.

I suggest some very simple ground rules, which should be very obvious:

A client’s mother can have great ideas about therapy goals.

A client’s father can have great ideas about therapy goals.

Any other suitable guardian can have great ideas about therapy goals.

The client themselves can have great ideas about therapy goals.

 

Sometimes these suggestions don’t make sense to us as professionals, sometimes they aren’t age appropriate, sometimes they don’t fit current skill levels, but we don’t just ignore them and silence the people who are invested in the client’s well-being and growth. The whole point here is that there should not be this great distinction between what the Mom can contribute, and what the Dad can contribute. Once we assume one has better ideas, or more time, or more commitment, we do a disservice. Situations may play a role in what happens in actual practice, but those are going to be based on actualities, and not preconceptions. Preconceptions acted on as though they are obervations are not behavior analytic.

Now, there also may be things that we notice between male parents and female parents that are a little different. Sometimes these things are stereotypical. Sometimes the interests follow expectations that we see generalities of in our daily life. We need to make sure we don’t assume too much with these. Treat every situation as though you will be proven wrong. Treat every situation as though you will learn something. Assuming too much is where we always get it wrong. Overlooking things is not scientific.

Data Point of One (Personal Experience Talking)-  On a case, I had a father once who had a different view point on some social goals. There are some situations where the current social goals put the client in what the father called a “weak position” to their peers, based on some peer interactions that had gone a bad route.  At face value, we could either say “NO! The client is expressing themselves! That’s good! What happened wasn’t their fault! Get out of here with that victim blaming!” or, we could take a minute and understand the meaning and sentiment of that worry. The client could be taken advantage of. Social hierarchies exist. Kids take advantage of other kids. Kids hurt other kids. The specific operant behaviors we were teaching here might actually be reinforcing peer aggressive/hurtful verbal behavior. It’s possible. We should probably take a look. Behavior does not occur in a vacuum. It ended up being more complicated than that, but the analysis was warranted. It helped.

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Both parents can contribute. No matter the gender, no matter the outlook, most of the time if you find a parent who cares about their child enough to attend meetings, put the time into the trainings, and are enthusiastic about transferring and generalizing skills, you’ll find someone who can make a contribution to the growth and progress that can not be underestimated. The more hands on deck to getting the client the skills the better. We want more people on our team. We want more people showing love to the client to get them where they can thrive. A large support structure that loves and cares for an individual can make all the difference. We as professionals don’t get to decide who gets a voice and who doesn’t. That’s the lesson.

 

Comments? Questions? Thoughts? Leave them below.

 

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Getting a Behavior Analyst House-Call

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Behavior Analysis is different from other psychological therapies. First, it is considered a natural science, meaning that its interventions rely in manipulation of real world variables that can be observed. This removes some of the stereotypical therapeutic long talks on a couch for viable behavior analytic therapy, but don’t sell behavior analysis short just yet.

The best evidence based practices in applied behavior analysis can be found in the natural environment, both studying participants behavior across those environments. It looks at the patterns of either prosocial behavior that can be therapeutically reinforced , and identification and reduction of maladaptive behaviors which get in the way of a fulfilling life.

One of the founding psychologists of behavior analysis, B.F Skinner, wrote in “Science and Human Behavior” (1951) about both the experimental setting for behavior analysis, and the paramount importance of seeing behavior in the environment in which it behaves. Doing tests in a lab may be helpful to get behavior analysts some solid and clinically controlled data sets, but it could never tell them if those skills or patterns would generalize a certain way in the world outside. There’s an importance to that. One of the founding dimensions of behavioral analytic science demands that the products have Generality meaning that the effects of therapy occur across environments and time. The benefits of therapy must outlast the clinical visits. This is helpful to the clients and consumers of behavior analytic therapy (ABA) for obvious reasons; you want the therapy to work in the places you need it most.

ABA practitioners use two broad tools to shape the direction of therapy a Behavior Plan to identify maintaining factors for maladaptive behaviors, and a Skill Acquisition Plan to build up the better patterns, skills, and coping behaviors to replace them. It is all about identifying the problems fast, and implementing actionable change. To that end, they need all the information they can get. Location matters.

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When it comes to the location of services, both for client/consumers, or perhaps the children of client/consumers, age becomes a factor in where this therapy takes place. In many cases this could happen in a school setting, or clinical center setting. This is a practical and commonplace service location for clients of therapy of younger ages. The school setting does have naturalistic opportunities that the clinical setting does not, and having the opportunity to receive therapy in both has its benefits. Clinical settings can focus on the skills that can be practiced with controllable conditions and stimuli that do not have the scheduling drawbacks of an academic setting. School settings have the benefit of natural peer environments, and natural contingencies for task demands if behaviors are dependent on those factors. What is often overlooked, however, is the home setting. I practiced as a School Counselor, and although certain types of therapy worked in the school setting and helped the students, once they walked out the door, the practitioner had no idea. It was all self-report from homes, and those can be misleading.

The benefits of having a house call from a behavior analyst (BCBA), and getting ABA therapy at a residence, is that the practitioner can see the conditions outside of the clinical and academic sphere that may be relevant to either stifling patterns of prosocial behavior, or feeding into the maladaptive behaviors. Sometimes the home environment is rich in information and reinforcement history that an analyst can work with. Routines, schedules, and practice can all be built into a home visit to work on the things that need the most work. Sometimes the privacy and comfort of the home also helps with going through dry runs of new skills without the social pressure of the outside world. When a Behavior Analyst comes in through the front door they are interested in getting to the bottom of the problem behaviors, teach socially relevant alternatives, and most of all, to help. I’ve seen first hand how just a change to familiar scenery can open up dialogue and planning for therapy directions that might be uncomfortable, or even embarrassing elsewhere, so never underestimate the power of an environment change on behavior.

Some Practitioners might not be able to deliver consistent services in the home, but even one occasional house call, one single visit, could open the lens on new conceptualizations on the therapeutic framework. I’ve experienced this countless times. As a practitioner, you think you know what’s going on, and then you’re in the client’s place of residence and a big piece of the puzzle falls into place. This is advice to any behavior analytic practitioner; if you have the opportunity to make that house call, don’t wait. It could change your entire idea of what is going on and save hours on dead end functional analysis hypotheses. House calls can also get the broader family involved with services that they might have otherwise been unfamiliar with. This opens up dialogue, and questions, which could lead to greater support both inside and outside of the home. There is a well known tenant in behavior analysis called dissemination. That means, this natural science works best when people know about it and understand it. Spreading the word, and being correct in the delivery of what ABA therapy is, is important. There is no short supply of misinformation out there. A home visit with the family, willing to participate, can break down the barriers of hesitancy, and show just how effective and useful this therapy can be.

So potential clients and consumers? If you can swing it, call for a home visit.

Behavior Analysts and ABA practitioners? Don’t be afraid of house-calls. You’ll be kicking yourself for not doing it sooner.

Questions? Comments? Thoughts? Leave them below.

Interest in ABA therapy for resources in getting services, or practicing? Feel free to email the address below.

References:

Cooper, John O, Heron Timothy E.. Heward, William L.. (2018). APPLIED BEHAVIOR ANALYSIS. S.l.: PEARSON.

Skinner, B. F., & Skinner, B. F. (1951). Science And Human Behavior. Riverside: Free Press

Photo Credits: http://www.Pexels.com

Overcoming the Fear of Failure

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This is a topic I see very often in clinical practice. Not only that, but it affects everyone at one point in their lives. When I am working on skills with my clients who are able to vocalize and express these fears, I see a pattern inherent to everyone who has ever encountered something new. In Applied Behavior Analytic research, sometimes we like to operationalize this phenomenon as “aversion”, or “presentation of an aversive novel stimulus”. Whatever we call it, it is the same thing. Engaging in something new and uncomfortable in a goal directed way is a challenge that we have to confront. Clinically, I prefer to have the individual guide their own process and become aware of their own specific aversions and behaviors. It makes the practice of confronting these stimuli as self-initiated, and self-guided as possible.

I prefer the word confront because it has a better ring to it than “desensitization”. When it comes to coming face to face with a stimulus or situation where we have to either perform or adapt, confront just seems to carry the operant theme more than the passive “desensitizing”. Failure is a scary and aversive thing.  We can define it as a condition where our operant behaviors are unsuccessful. Efforts which are not reinforced. It’s perfectly natural to want to avoid a contingency with no reinforcement. When we face something we are afraid of, or a new situation where we might not be sure we can succeed; we are facing that fear of failure. Maybe it is a fear of not being able to complete a required activity of success, or putting yourself out there socially and being received amiably. There is something universally human to that kind of hesitation. In ABA we call that an “escape-maintained” behavior, and when the behavior serves no real purpose to protect us, it tends to hold us back. When failure is that fear, then we tend not to even try.

In clinical practice, be it Applied Behavior Analysis (ABA) or any other Cognitive Behavior Therapy (CBT) the advice is all the same; it takes presentation (and sometimes repeated presentation) of that stimulus in a controlled situation until that aversive situation becomes neutral. This is called controlled exposure. That is where the real progress happens. When someone meets that situation, faces it, and can come through the other side fearing it less (or finding it less aversive), it is a step in the right direction. You may also hear the term “graduated exposure”, which denotes the concept of fading in stimuli or related stimuli in from least to most in order to acclimate in steps. A common example is if someone is scared of spiders or animals, they would be shown a picture first across the room, and gradually get closer to the picture before moving on to any examples of the real deal. Habituation is the term commonly used for becoming used to something, to the point where the stimulus becomes tolerable, if not neutral.

These same principles can be used when actively trying to overcome a fear of failure too. Generally, we come across things that are new to us. These can be either unconditioned stimuli (things we are “naturally” fearful of) and conditioned stimuli (things we have learned to be fearful of). Public speaking in front of large groups is an example of an unconditioned stimulus (for some, but it can be conditioned for others) while taking tests is a common example of a conditioned stimulus. Both present a challenge that we have to act on (engage in operant behavior) in order to be reinforced. Be it someone you are helping in clinical practice, or yourself, you can use these same foundational principles of graduated exposure. If the situation is not reinforcing in itself, keep in mind that you can always improvise your own reinforcement (reward) in order to make adapting easier. Using reinforcement alongside challenging situations can make them less aversive through a process called conditioning. The act of practicing this process on yourself is called self-management.

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Consider these steps when trying to formulate your own graduated exposure:

  1. Find the situation which you feel is important to engage in or achieve (Target).
  2. Break it down into it’s smallest components (Task Analysis). 
  3. Pinpoint which part, exactly, is causing the most aversion or fear (Aversive Stimulus). 
  4. Document, to the best of your ability, the behaviors you engage in along the way (Data Recording/Self-Monitoring). Do these behaviors help, or do they hinder? 
  5. Practice engaging with a facsimile or similar situation where the stimulus or stakes are not so high (ie. If public speaking is the target try practicing a speech in front of 1 person first). 
  6. Reinforce (reward) any toleration or approximation of success! This is the most important step. 
  7. Gradually shape these practice simulations to simulate the “real” objective as closely as possible. 
  8. Do not rush it. Challenge yourself, but be mindful that this is a process, not a race.

Take it slow. Document everything you can. Learn. Improve. The process is where the fear of failure is overcome. Often it takes more than one contact with the situation to get accustomed. I’ve used this process on myself more times than I can count. As a person who has found large exams, public speaking to crowds, public competition, and even engagement in new and unfamiliar situations; the end-goal is all the same. It is something that is worth facing because the outcome is a socially important, or beneficial to us. The aversion, or fear, is not helpful or adaptive. Facing these situations and designing the process oneself is empowering.

Self-Management is one of the greatest strategies in ABA. If someone can find a way to manage their own behavior successfully then it is the ideal situation. Self-monitoring and self-management also have the unique bonus of being able to handle what Behaviorists call “covert behaviors” (thoughts, etc). Covert behaviors are things that are not visible to outside observers but are still able to be tracked and recorded by the person experiencing them. Accuracy and specificity is important here, and can vastly improve a personal insight into their own patterns of behavior. This doesn’t have to be a single person job either! Even though someone can monitor their own behavior, they can also bring trusted friends/family/cooperators into the process of reinforcement and help to keep them on track.

Independence, and knowledge about yourself, while overcoming a challenge.

What could be better?

 

Comments? Questions? Leave them below!

 

References:

  1. Cooper, J. O., Heron, T. E., & Heward, W. L. (1987). Applied behavior analysis. Columbus: Merrill Pub. Co.
  2. Wood, S. E., Wood, E. R., & Wood, E. R. (1996). The world of psychology. Boston: Allyn and Bacon.

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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:

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