Saturday, May 11, 2013

Pairing & Developing Rapport




Pairing” is a common term that ABA professionals often use to describe the process of building or maintaining rapport with a client. Therapy often begins with intentional and thorough pairing, where its ALL about what the client loves or enjoys and making that available to them on a non-contingent basis (jargon defined: for FREE). Basically, the therapeutic relationship should start off with low demand, and high reward.


 When done correctly, the client will see the ABA professional walk through the door and connect that to receiving good things/having fun.




I have mentioned pairing before on my blog, but this is the first full post all about pairing. Pairing is one of those ABA activities that some therapists just LOVE to do, and some therapists find challenging. I can't tell you how many times a therapist has said to me "...But, I don't know how to pair with him".
 I think this is because so much of pairing can be unstructured, client-led, and loose, that for some individuals it feels like doing nothing. Or it feels like wasted time. I have even had parents complain to me that the staff is "just playing" with their child and need to get to work already. 

I have also worked with ABA therapists who are amazing at pairing and building rapport. One of my previous staff referred to herself as "Mary Poppins on crack". :-) Correctly so, I would say.

Pairing in its simplest terms is just being the embodiment of a toy. When I am successfully paired with a child, I feel like a gigantic toy. The child is pushing and pulling on me to get me to engage with them, ordering me around (“No, sit with me Ms Tameika!”), excited to see me arrive and bummed to see me leave, responsive and cooperative during work tasks, and and any activity is more exciting if I do it too.


The therapeutic process should begin with intentional pairing. Even if you already know the child, you shouldn’t immediately jump into presenting demands. Pairing is how therapists establish instructional control, build trust, connect themselves to reinforcement (eventually becoming a reinforcer), and get to know the child’s interests. Skipping the pairing process can cause problem behaviors to increase, kill instructional control, and impair the therapist-child relationship. If I am not properly paired with a new client and I just walk in and start giving orders, what is motivating the child to do what I say? What is motivating the child to want to come and play with me? 
What you could unintentionally do is create a situation where the child is doing things you ask to get away from you. So you place a demand, the child answers, you provide reinforcement, and the child walks away/leaves the room/elopes. That is definitely NOT a situation you want. It’s no fun for you or the child to have to chase them around the home. 

You will know pairing has been successful when the child is consistently coming toward you, or approaching, and not walking away from you, or escaping. The whole "Im-going-to-play-alone-with-my-back-turned-to-you" thing is like a red flag that you have more pairing to do.


Pairing is all about social reinforcement and enthusiastic engagement, which is often hard for the children I work with. They just don't find social interaction all that interesting.

Pairing is not something you do for a few days with a new client and then never do again. I have worked places that taught us pairing rules like: pair for the first 5 sessions, or the first 2 weeks, and then transition to placing demands. Research does not support these kind of blanket rules. 

Think of pairing as something to be implemented prior to task demands, not just when starting with a new client. I actually teach my staff to briefly pair at the top of all therapy sessions, and to continually conduct brief reinforcer preference assessments to make sure they are approaching the client with what that client wants, in that moment. This is a far more effective way to think about pairing......it is not something to check off a list and then never do again. Its a way of embedding client interest and just good ol' FUN into your sessions, so that work is gradually embedded into play, rather than being a jarring transition.


There is one last benefit of the pairing process that I feel is sometimes overlooked. Successful pairing teaches the child that I am fun and when I show up at the house good things happen. So in the future if we have a bad session or the child hates a program I am trying to teach, they can separate the task I am asking them to do from who I am. In other words, they can dislike what I want them to do and still like working with me.

Here is a simple mock up of the first few days of pairing with a new client, and what that progression could look like. 
This is not a template that has to be followed, remember pairing is NOT a dry recipe to follow! Rather this is a sample of how task demands can be gradually increased over time:

PAIRING PROGRESSION

Day 1: Introduce myself to child. Observe the flow of the day and how the child spends their day. Act more as an observer than an active participant. Shadow the parents as they engage with the child so I am connected to reinforcing people (the parents). Place 0 demands on the child.
Day 2: Greet the child. Begin to connect myself to known reinforcers. If child loves to swing, push the child on a swing. If child loves going to the park, take the child to the park. Praise appropriate independent behaviors, such as eye contact or sharing (“Thanks for sharing with me!”), and have lots of playful interactions doing what the child wants to do. Do lots of narrating or mimicking during the play. Follow the child’s lead. Introduce some task demands in the work area.
Day 3: Greet the child and begin to prompt a response. Restrict access to reinforcers by being the one in control of reinforcing items. Spend more time in the work area, or increase ratio of demands to breaks. Begin to incorporate social reinforcers into play such as having a babydoll give the child kisses. Praise appropriate independent behaviors, such as eye contact or sharing, and have lots of playful interactions doing what the child wants to do.
Day 4: Greet the child and wait for them to respond. Arrive to the home with a Grab Bag of reinforcing items to introduce during the session. Restrict access to the reinforcers by placing demands on the items. For example if the child wants a pinwheel out of the Grab Bag require them to spin the pinwheel once (prompt if needed), then immediately praise the spinning and give the pinwheel to the child. If the child is vocal begin to require they label reinforcers to get them (hand the child a ball but don't release it until they say “Ball”). Increase amount of social reinforcers used during the session to a few each hour; label the name of the activities as you do them. For example, lift the child into the air and say “You’re an airplane!” Begin to have the child follow your lead, e.g. As you are playing with the child on the floor stand up and yell “Chase me!” and then run into another room. Reward the child following your lead with tickles.


*Quick Tip: Here’s a link to a massive variety of social reinforcers. Try to mix in 5-7 different ideas into each ABA pairing session.

*Awesome article explaining the process of Pairing: http://www.bsci21.org/how-to-get-your-client-to-listen-to-you/



15 comments:

  1. People recommend pairing without much empirical evidence of its effect. My dissertation research specifically looked to assess the result of presession pairing on challenging behavior and correct responding during discrete trial teaching (DTT). My research abstract, references and powerpoint are available online.
    http://www.behaviorbabe.com/presessionpairing.htm

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    1. Thanks for sharing Pairing research!

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    2. Amanda, the link is not working. Would you be able to email it to umut.catron@gmail.com? Please and thank you!

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  2. Dear Tameika,
    Love to read your blogs and books! You mention that you are a left brain oriented therapist and long for structure and order. I am doing some research on the skills you need to have to work succesfully with special needs children.
    This must result in an assessment that I can use during job interviews to hire new therapists. I also want to use it when I talk over functioning with current staff members so they know on what skils they have to work on.
    I have some views from parents and trainers/coaches but now I am searching for literature on the subject. Do you know any interesting material? Thanks for your help in advance.
    When my tool is ready I will send to you (english translated).
    Michel, The Netherlands

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    1. Hello Michel!

      Im so glad you enjoy the blog, and thank you for checking out my books :-)

      What an interesting topic of research! Im sorry, but no I do not know of other relevant articles or publications on this topic but I am quite interested to see what results you obtain from your research process. I have worked with all types of ABA therapists (R brain, L brain) and while I do think there are certain traits that help for this type of work (such as being organized and flexible), I also think when a child gets to work with a variety of people, then learning is varied which can be great. However thats just my opinion. Good luck with your research!

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  3. Love this list of social reinforcers! Did you create it?

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    1. Thanks! No, it was shared with me by a previous supervisor.

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  4. Thanks for this post!! Really amazing the link for the Social Reinforcer!!

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  5. Thank you!
    I didn't create the list, but I had permission to post it :-)

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  6. You have to be excited. Even if you have to fake it and don't just observe the child but play along side them. At first I was Kinda thinking that I should be my real self with the child, but if my real self is unexcited and I go that route, I do the child a disfavor. The child is worth my excitment Even if i dont feel it.

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    1. Yes, enthusiasm is KEY!

      Thanks for commenting :-)

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  7. Hello, I was just recently hired as an RBT and am researching info on the pairing process. I found your article very informative. I noticed that the link to social reinforcers has been discarded. Is there a way I can gain access to it. My email is becca.bruno@gmail.com. I would really appreciate it. Thanks in advance.

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    1. Hi there!

      The link is working fine. Sometimes people cannot access the links because they are using a work or public computer (they can have blocks for opening external files). Try using a different computer to access the link.

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  8. Just started as an ABA Therapist. My first client is non-verbal. Have any ideas about pairing? I've seen, more than once, (and was told by a trainer) that narrating isn't always a good strategy for pairing with non-verbal learners. Do you have any thoughts on this?

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    1. Hello,

      I haven't heard that before. Most of my clients have been very young, non verbal or non vocal individuals, and I had no issues with narrating. It was actually the opposite; it was quite helpful. Many of my very young clients could easily ignore me playing near them, staying in close proximity, or handing them reinforcers, but if I would say excitedly in a loud voice "BOOM, blocks fell down!" that would get their attention :-)
      I might get a quizzical look, or sometimes a smile, but it would help the child be more interested in me when I started to describe or talk about what they were doing in a very animated manner.

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