Observing Therapy Sessions

Photo source: www.researchhistory.org, www.goodtherapy.org

I've said it before, and I'll say it again: parent participation is critical to the success of any ABA therapy program.

One way that participation can be accomplished is by having parents/caregivers observe the therapy sessions. Particularly when therapy first begins, it may be too challenging to have the parent join the session. This can be challenging for the child, who may not want mom or dad in their therapy session, and it can also be challenging for the parent who is still learning what ABA entails. So a nice compromise I like to do initially is just have the parents sit and watch the session without joining in.

I have a pretty big dislike for therapy sessions that only go on behind closed doors. I do not think that the therapist should arrive at your home, go into the therapy area, close the door, and then in a few hours you see them again as they leave. How is that helpful for the family who urgently need to learn how to generalize what the therapist is doing? From the child’s perspective, this sends a message that they only need to listen to their therapist. So when the therapist leaves…..things can get very hard for the parents.

Treatment should occur naturally and within the context of the typical environment. This could look like playing games at the kitchen table as mom cooks dinner, or practicing bike riding in the driveway next to some siblings. I love to see therapy sessions that are active, loud, full of laughter, and move freely from room to room. 

Many parents are unsure of what to do when I ask them to start observing, and for some it can even be an uncomfortable or unenjoyable experience. ESPECIALLY if just the sight of you walking into the therapy area causes your child to erupt in problem behavior. If that happens to you, don’t feel alone. It’s pretty common. This just means your child needs more opportunities to get used to your presence during their therapy session, but it definitely does not mean you should leave/walk away when this happens. That will only serve to strengthen an escape response where your child acts out in the session to get you to leave.

So now that you know not to leave in response to problem behavior, what should you do while observing a therapy session? Glad you asked 

1.       Observe the dynamic between the therapist and your child- You know your child better than anyone, so what you are looking for is a healthy respect for who your child is as a person. If your child squirms away from touch, does the therapist keep giving huge bear hugs anyway? Does the therapist speak to your child with respect, or in a degrading tone? Does the therapist seem bored or disinterested while teaching? These are all bad signs.
2.       Observe the reinforcement your child receives – What reinforcement is being used? Is it varied, and delivered frequently? Is praise delivered along with reinforcement, or does the therapist just silently hand your child a toy or edible? What if your child seems bored with the reinforcement, does the therapist pick up on that?
3.       Observe how correction or prompting is given during instruction – When your child gives an incorrect response or stops responding at all, what does the therapist do? How do they react? Do they appear frustrated, flustered, or annoyed? If you can read that in their face, so can your child.
4.       Observe how the behavior plan is implemented – Firstly, if there is a behavior plan you should be familiar with it. Observe how the therapists implement the plan, and if they are following it. Are you seeing the antecedent strategies being used?  If your child becomes aggressive, does the therapist know how to react in a calm and neutral manner?
5.       Observe both professional and ethical behavior – This is probably my #1 reason for recommending parents observe, from the perspective of a parent. When I have on my BCBA hat, I want you to observe to learn the treatment plan and ABA strategies. But when I have on my parent hat, I want you to observe to make sure you are dealing with professionals. If you are unaware of the ethical and professional standards for this field, please become familiar with them. Here is a link to the standards for this field. If you directly observe violations of these standards, that is absolutely a bad sign.
6.       ASK QUESTIONS- This is so important I must say it again: ask questions!  The ABA team are not in your home 24/7. It is super important that when they are there you use that time to bring up concerns, problems, or questions. Ask about behaviors, the treatment plan goals, bring up your concerns about the upcoming school year, etc. The team should answer your questions respectfully and simply, minus a bunch of jargon. I also suggest using therapy session time to practice things that are particularly difficult when the team is not around. For example, if you have a rough time every morning getting your child to brush her teeth, practice that skill with the staff during therapy sessions. That is why they are there after all, is to help you!

Just like any new skill, ABA will be so much easier to learn once you have seen/observed what it should look like.
One of the best ways to truly learn how to implement the treatment plan is to watch the professionals do it, then ask questions about any parts that seem confusing…or ineffective…..or overly punitive. I have had some parents ask me some very probing questions which led to some great moments to teach about the application of ABA.  

*Suggested Reading: The Rights and Wrongs of a Parent Observing Therapy

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