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There are many reasons why I stop working with clients: sometimes they move, they lose access to funding, they improve to the degree they no longer need for my services, or for personal reasons the family needs to take a break from treatment.
 Then there is another category of why people quit therapy, it's like that dark, wooded area in the back of the park that no one likes to talk about.

Sometimes clients halt treatment because they started ABA services expecting Happiness, and instead all they got was Therapy.

Maybe you are a parent who tried ABA therapy for your child, but to your surprise, the child cried a lot. Or their behaviors grew worse. Or tantrums got worse. You probably thought to yourself, "Hey! What's going on here? This is not what I signed up for". Actually, it is.

Now's a good time for a disclaimer:

"Therapy" is a treatment intended to help alleviate symptoms of, or to relieve the more debilitating impact of, a particular issue, challenge, disorder, or disease. Therapy is not synonymous with being treated poorly, being treated unethically, or being convinced you need something that you really don't need. If you had bad, poor, or horrific experiences with therapy, it's likely that was not actually therapy, rather it was some unethical and harmful service being sold to you as a therapy. 

End disclaimer.


Now that we have a solid definition of therapy, what should parents realistically expect when initiating ANY new therapy (Occupational therapy, Speech therapy, ABA therapy, Mental health counseling, etc.)?

*Difficulty - Therapy is difficult because areas of deficit are being targeted. The very things selected to work on are things the client either cannot do, or cannot do well. This means therapy will push us outside of our comfort zone, and be uncomfortable or hard at times.
*New challenges - By its very nature, therapy must challenge the client. If therapy does not push/challenge the client, then that is not real therapy.
*Resistance - All the science geeks: you know that every action has an equal and opposite reaction, right? Okay, so what happens when a therapist challenges the client in an area that is already weak? It's called resistance
*Commitment Requirement - ABA therapy is not a free sample at the grocery store, or a trial sized bottle of shampoo. You get out what you put in, and commitment is required for progress to stick around. Canceling sessions, starting sessions late, continuing to reinforce problem behavior, or applying different strategies than what the ABA team is doing, will all have an impact on the overall effectiveness of treatment.


Do you see happy in that list? No. 
Does that mean I'm saying therapy is all bad, all the time, and you should expect your child will hate it? Of course not.

But what I am being very intentional in saying is that the GOAL of therapy is not "happy". The therapy team will develop many treatment goals designed to improve quality of life, and quality therapists do strive to be fun, engaging, exciting,  and playful. What we do not strive to do, is keep your child happy all the time. There will be sessions with tears, or tantrums, or anger. This does not shock us as treatment professionals, nor should it shock you as the parent. I have clients who get angry at me because I don't just sit back and allow them to do dangerous things, like jump off kitchen counters. So be angry with me, I'm fine with that.

Treatment is hard. Treatment will take you out of your comfort zone. Treatment will push your boundaries. Treatment will impact the whole household, not just the child receiving therapy. Significant gains must be accomplished through significant amounts of work. The therapist will work hard, you the parent will work hard, and your child will work hard. If this is sounding unreasonable to you, or unacceptable, then it's likely therapy is not a good choice..... And that is okay. 

What's most important is knowing the reality of therapy, what it is and is not, before you jump into it.


Photo source: www.tombruetttherapy.com


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*Recommended post: Professionalism


Confrontation is not a bad word, but it sure makes people UN-comfortable.

As BCBA's/therapists/ABA professionals, the need to confront an issue is pretty much a job requirement.
If you're a RBT, you may find yourself needing to confront your BCBA. If you're a BCBA, you may need to confront a parent of a client.

None of us are really exempt here, unless you are totally cool with people walking all over you. If that's fine with you, then I wish you the best of luck and you can stop reading now.


For the rest of us, part of being a professional will involve having to resolve conflict or disagreement with other people in a respectful way. As in, having to arrange a sit down meeting between THAT parent and the ABA team over issues that have been simmering for weeks. Yeah, super not fun....I had to do that a week ago,

No one really told me pre-certification that a big part of my job would be conflict resolution, but it kind of is. On a regular basis. Not just when things completely fall apart, but longgg before they reach that point.

I've learned from experience that the way you approach resolution can either guarantee a disaster or help prevent one.
Here's what I mean:

To confront, means to face up to or deal with a difficult situation or problem.

To establish and maintain boundaries, means to mark or designate a dividing line; to clearly set a limit.


Wow. Those definitions make things pretty clear. It's a far more effective use of your time, not to mention less stressful, to focus on communicating your boundaries, than to ping pong from one confrontation fire to the next.


So as a professional, how do you establish and maintain boundaries to avoid reaching a place where you now must confront someone? By thinking through the following:

Where do I draw the line as an individual professionally, both personally (unique personal preferences) and ethically?
Once I have decided on my "boundary lines", which of these will I die for? (translation: which boundaries are the most critical)
How am I doing at clearly informing people about my boundaries?
Do I let people know when they have crossed a boundary (follow up: Then how will they know??)?
When someone repeatedly crosses a boundary I have made clear, how do I resolve the issue calmly and quickly?
If someone repeatedly crosses my boundary, is the problem with my boundary? Is the problem with me? Or is the problem with them?

Over the years, I've had angry and tight-lipped confrontations with supervisors, employers, supervisees, and parents/caregivers of clients. I have also clearly explained my boundaries, and then quickly alerted someone when they crossed/stepped on one. I much prefer the latter.

Especially for an ongoing relationship, like a supervisor you work with across multiple cases, it's better to win the relationship than to win the argument.

Just to name a few examples, as an ABA professional it's important to define for yourself where your boundaries are regarding:


  • Types of clients you will serve
  • Schedule/Availability (desired work load)
  • Training/Learning preferences
  • Communication/Correction preferences (this one is a biggie)
  • Opportunities for promotion/raises/recognition
  • Multi-disciplinary collaboration
  • Dealing with uninvolved or resistant consumers/clients
  • Creating that work/life dividing line; Maintaining balance


Instead of spending energy on very impressively worded confrontations, choosing to have a respectful discussion about boundaries moves you closer to maintaining the relationship.

If people don't want to work with you, even if you won the argument you definitely lost the war.



Photo source: www.addicted2success.com


*Recommended Reading: Getting Parent Buy-In


Trialability - The degree to which an innovation is perceived as better than the idea it supersedes; how easily potential adopters can explore the innovation. 

Trialability basically refers to "How much will it cost me to give this a try?".
ABA therapy can be a difficult thing to "try". It isn't like tasting a food sample at the mall, or watching the first 5 minutes of a new sitcom to see if you like it. The costs of ABA are many, and for some, quite high.

To name a few, ABA therapy will demand:
Time, Materials, Mental Energy, Physical Energy, Training, Working Through/Past Discomfort


As professionals, we do consumers a disservice when we do not properly enlighten them, from the onset of services, of the hard work that is necessary for ABA therapy to be effective. I have worked with families who started treatment with a "Ok..guess we'll try this" kind of attitude, and to put it nicely: we didn't work together very long.

Am I saying every consumer needs to be an ABA expert before they pursue treatment? No. But its like training the body for physical exertion: jumping in with a minimum level of commitment will almost certainly lead to quitting as soon as things get tough or painful.
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