"Time to Work": Preparing the Client for Instruction

Photo Source: www.magnoliabehaviortherapy.com

As an ABA practitioner, sometimes it can be difficult getting the client you are working with engaged in the therapy session. 

There will be good days and bad days working with clients, and it's normal that your client won't be excited about completing tasks every single session. 
However, if you are finding that every time you arrive for a session the client runs from you, begins exhibiting problem behaviors, or becomes upset, then something is definitely wrong with the therapeutic relationship. Strong rapport is necessary in order for therapy to be most effective.
This is important for several reasons:

Firstly, much of what we do as ABA therapists relies on a reinforcing or "paired" relationship with the client. If the client is consistently trying to escape work/you, then pairing becomes very difficult and you will become an aversive.

Secondly, it's unlikely that after you heavily prompt the client to the work area, that you will get a good session out of that client. That is the equivalent of your boss waking you up in the middle of the night to go to the office and do some work. You just aren't at your best. We definitely want to work with clients when they are at their best, or as close to that as we can get.  

Lastly, successfully getting your client ready for a session teaches transitioning skills. Moving from pre-work mode (whatever the client was doing before you arrived) into work mode is a BIG transition, and if you can teach the client to transition appropriately into a session then it should be easier to make small transitions during the therapy session.

Usually if a therapist is consistently having difficulty with a client during the therapy session, it's for one of the following reasons: the therapist isn't properly paired with the client, the parents aren't properly preparing the client for a session, or the therapist isn't implementing reinforcement properly. 

  • Issues with PairingRapport Building, aka Pairing is a critical part of instruction. Pairing is an applied strategy based on reinforcement where the therapist pairs demand with reinforcement, so demands become less aversive *(translation: fun things happen when the instructor shows up). Don't think of pairing as something that is done once, and then never again. Effective pairing should occur regularly, or be embedded at the start of all instruction. How long does it take to play a quick game with the client, or watch a few minutes of their favorite video? Not long at all, and the benefits of starting off the session that way are very much worth it. Taking the time to pair properly will ensure more success once demands are placed, as well as higher motivation for the client to interact with you.
  • Issues with Preparing the Child for A Session- Therapists, you may need to help the family understand how to get their child ready for a therapy session. You can be the most fun and exciting therapist around, but if right before you arrive at the house the child is jumping on the couch, watching cartoons, and eating a Snickers bar, that child will likely get pretty upset when they hear that doorbell ring and see you walk into their house. Depending on the child, at least 15-20 minutes before the session the parents need to begin making transition statements. Something like, "It's almost time to turn the TV off, because Ms Jane will be here soon". Give the child ample warning that it is almost time for therapy. Another way the parents can help you is by using a visual schedule and showing the child on the schedule that after TV time it is time for Ms Jane. Parents can also make sure the child is fed, clean, and has been to the toilet before each ABA session. The therapist should not have to try to motivate a hungry, thirsty, or wet child to participate in a therapy session.

  • Issues with Reinforcement-  I could write an entire post on reinforcement alone, so I will just discuss a few points here. It's important to always keep a balance between reinforcement and demand. If demand is too high, the client may start exhibiting challenging behaviors or try to escape you. If demand is too low, the client may tune out, withdraw, or become silly/giggly to entertain themselves. Try switching up your reinforcers by arriving to the session with a bag of reinforcers and toys. Once you get into the work area, open the toy bag and start playing with the client. This is a painless and simple way to do several things: get the client into the therapy area, maintain client motivation, and transition the child from "pre-demand" to demand.

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