Ask An ABA Therapist

A Trained ABA Therapist Answers a Parent's Most Common Questions
By Megan Kenny

No training could prepare me for the lessons I learned during my six years as an Applied Behavioral Analysis (ABA) therapist interacting with and studying the autistic mind. Especially humbling was the pain and helplessness that parents can feel after diagnosis. I hope this question-and-answer will help ease that hurt and lend a hand to those in need.

How should I interact with a therapist?

Be your unapologetic self. Establishing a comfortable, respectful, communicative, and honest relationship with the therapist is paramount. A natural exchange will lay a strong foundation upon which to build a successful program. Therapists can gather more accurate information and, in turn, implement a stronger program when they know that they are witnessing real situations. Put aside any fear of judgment and be nakedly honest.

Don't turn to the therapist for your own needs, though. The therapist is there to support the family but is not to be a substitute for psychological help. If you need help, ask the therapist for advice as to where to go, but don't use him/her as the solution. It is simply too much pressure.

What questions are okay to ask my therapists?

Questions regarding therapy and autism in general are obviously appropriate, but questions about the specific progress and programs of other children are not. Confidentiality should be respected and maintained by all involved.

The question “What would you do?” can be difficult to answer, depending on the context in which it was asked. When posed in relation to behavior management, for example, the question is relatively tame. On the other hand, when referring to in-family dealings, the therapist might be unable to answer. While the therapist may feel like part of the family, he/she shouldn't participate in solutions the family decides privately.

Along those lines, delving into the personal lives of therapists can also be risky. The objectivity of both parties can become cloudy when the relationship between the therapist and the family is too familiar. Leave it up to the person being discussed to which level the discussion goes.

What do therapists find insulting?

Sending the child to school sick, or not canceling a therapy session when the child is under the weather. The fear of losing valuable therapy hours should not compromise the health of the child under any circumstance. Those hours are no longer valuable and the health of all people involved is jeopardized. Ultimately, the therapists begin to feel like babysitters and not like the trained educational professionals they are.

Don't interrupt a sessions to calm a child having a tantrum. One function (perhaps the most common one) of a tantrum is avoidance of a situation. If a parent “rescues” that child when he or she is exhibiting avoidance behavior, the child has now learned how to get out of doing difficult things with the therapist. And isn't that the point?

Not writing in a “communication book” is another problem. Teachers and therapists need to know how the home life is in order to make the program more successful. Sometimes the only way in which this can happen is through a notebook. When teachers spend time writing to tell you of the child's day, a response is validating and helpful.

Dishonesty is the ultimate slap in the face. The social circles in this field can get very tight. The truth will always reveal itself.

What are therapists afraid to say to parents?

Ideally, therapists should not feel afraid to say anything to parents. In reality, however, observations and objective opinions can easily be construed as judgments of character. The language used must be very specific so as to avoid such situations. Some anxiety also arises when the therapist is confirming the parents' fears. The delicate nature of some conversations can make for discomfort but, no matter how difficult the subject, everything needs to be discussed in an honest manner.

Should parents sit in on therapy?

If the parent is included in the session as a participant, or if it is a parent training session, then the answer is yes. But in other circumstances, a more successful session can occur when the parent is not present.

The simple presence of any family member greatly influences the child and can cause an increase in avoidance and disruptive behaviors. As with typically developed individuals, rules are different within the family versus those that are followed outside the home. Standards held by one person may be lower than those of another. The child might get frustrated and begin avoiding because he knows that one answer is acceptable to one person in the room when it is not acceptable to the person asking it of him. The focus, therefore, is diverted away from development and toward maintenance.

Should parents tape sessions?

Recording sessions is a very good idea. Not only is it an effective means of tracking the child's development, it can be a useful tool for therapists to monitor their own work. Initially, it can be an uncomfortable experience for the therapist. As long as the tape is intended and used for professional and therapeutic purposes, however, they need not be anxious.

The tapes should be easily accessible and reviewed regularly by the entire team to maintain an effective program. Again, as long as open and honest communication is the cornerstone of the relationship, all anxiety about passing judgment should be quelled.

Do therapists feel they are paid enough?

Tricky question. Appropriate wages can vary drastically, depending on experience of the therapist, standard of living in the area, and financial capabilities of the family. Some professionals are insultingly underpaid; others are insultingly overpaid. As for the former, business decisions are necessary evils, even in this extremely personal profession. The therapists should be willing to make them, and they should be allowed to do so. As for the latter, however, the decision lies in the family's hands. Therapists should be duly compensated for their stressful and difficult work, but if the family feels stretched to the limit perhaps a deal can be made. An honest and comfortable relationship should come in handy here.

Do therapists want you to invite them to have dinner with the family or do they want just a professional relationship?

In this field, the boundary between the professional and emotional relationship is easily blurred, especially when working in the home. Where the line stands, however, depends on the therapist. Problems can be easily avoided if the relationship remains separate, but if you feel comfortable, go ahead with the invite. The therapist should be able to make independent decisions and let you know what is comfortable.

What's the one thing every therapist wished parents knew or would do?

Be consistent.