In their own words: a client’s experience with ABA therapy.
By Kristin Smith, M.Ed., BCBA, LBA | CentralReach Instructional Designer
As behavior analysts, it is critical that we listen to our clients (i.e., the individuals who directly receive our services), as well as listen to the community of people who have previously received ABA services. Doing so pushes us to make the services we provide more socially valid, more assent-based, and more meaningful to those we serve.
There is much to learn from those who are direct recipients of intervention programs. What aspects of their intervention made it successful (or unsuccessful)? What did they look forward to? What do they wish was different? What can we as clinicians do better?
I had the opportunity to interview (e.g., actively listen to) an individual who received ABA services (referred to as “Cameron McGuinnes” in this blog post) for a significant portion of their life. When first conceptualizing our interview, I planned to try and identify what makes a good ABA program, in the broad sense, from the individual’s perspective and experience. However, I quickly realized that they had more to say about relationships with their service providers, and in their experience, the relationship is what made ABA a good experience for them. The individual was insightful, open, and honest about their experiences with ABA. I was deeply appreciative of their perspective and willingness to share.
Rather than my initial post-interview plan, I finished the interview thinking about the things that we, as a field, can do differently - and better - within our intervention programs.
The following is an abridged and somewhat re-arranged (for ease of reading) transcript of our interview, as well as my “takeaways.” Identifying and identifiable details are changed, including names, dates, and locations.
Note: There are three clinical team members discussed throughout this interview: the initial BCBA (Courtney), behavior technician (Eliza), and final behavior technician (Mikael). Eliza began working with this individual at the start of their ABA program as a behavior technician and then transitioned into the role of BCBA. There were many other service providers who participated in this individual’s ABA program, but for the sake of this interview/transcript, these are the primary providers discussed. All names are changed to protect the privacy of Cameron McGuinnes.
Kristin: When did you start ABA and how old are you now?
Cameron McGuinnes: I started ABA when I was two, like around two and a half, two and three quarters, something like that. I am 20 years old. I will be 21.
Kristin: How long did you have an ABA program, and how often did you receive services?
Cameron McGuinnes: I had it until, oh I’d say about 8th grade.
Normally, it was once or twice a week, as I recall. Once, twice, or three times. It fluctuated around my life.
Kristin: Did you have a say on how often those sessions happened?
Cameron McGuinnes: I was along for the ride, so they decided that stuff for me, based on what I needed and stuff.
Kristin: How did you feel about that?
Cameron McGuinnes: I mean, It was fine - I was fine. Again, most of this, I was just along for the ride… I had a good experience overall, and even though I didn’t have a say, really in anything, as I remember it, it was fine.
Kristin: How many companies did you work with?
Cameron McGuinnes: I don’t know much about companies, but I was always with whatever Eliza was with. I was just there, I was just along for the ride. I didn’t pay attention to that sort of stuff.
Kristin: Was your general experience with ABA good, bad, somewhere in the middle?
Cameron McGuinnes: Generally good- I mean, I was a kid. All I really wanted to do back then was watch TV, mess around, you know. Things an adolescent boy would want to do.
Kristin: Why did it (your ABA program) stop? Did you run out of things to work on or ask for it to stop?
Cameron McGuinnes: Well, one day during 8th grade, Eliza came to my house and she took me out. We went for coffee and talked about having friends and stuff and we had a walk..then had dinner at a...restaurant... Then we came home and Eliza talked with my folks a bit and she said, “You’re done, you’re done. You’re ready. He’s ready”
Kristin: Did you feel ready?
Cameron McGuinnes: Yeah I was like, ‘this is so abrupt’. I mean, I was going to miss my last therapist, but at the same time I thought this was a good thing.
Kristin: Did you feel like the ABA sessions were helpful, did they apply to your everyday life?
Cameron McGuinnes: A lot of that stuff did help with some stuff like with math, we were learning my times tables and yeah that was really helpful. And Language Arts, I think that helped a lot as well, even though I didn't understand why we were doing it at the time. And then there was stuff like talking about friends and stuff... I mean, like, we did a lot of stuff on language and stuff, and I knew it was going to help me.
Kristin: Tell me a little bit about the BCBA who was in charge of your program when you were younger. What were they like/what was your relationship like?
Cameron McGuinnes: There were times when Courtney would come over to my house and she would do reviews and stuff like that, and Courtney was a tough lady. And yeah she was, like, really strict but yeah... Yeah we overall we had a good relationship.
Kristin: What do you think made that relationship good? Like, there are times you cannot stand someone who is strict, and times you still like them even if they are strict.
Cameron McGuinnes: It was mostly that when we were working, but overall I knew Courtney was a wonderful person, and had the best interest in me. I felt like all of my therapists and consultants had the best interests for me.
Kristin: Did you ever feel like anyone didn’t? Did anyone ever do anything you didn’t like?
Cameron McGuinnes: No. They were all really nice to me. I cannot remember one bad incident on their part.
Kristin: Was Eliza with you/has she known you since the beginning, when you were 2?
Cameron McGuinnes: Oh yeah, oh yeah. Eliza and I go as way back as 2, 3 years old. And I consider her a good friend now, and mentor… I’m eternally grateful for everything Eliza has done for me.
Kristin: What made Eliza and Mikael good? Or made you like working with them? I know you really liked Mikael.
Cameron McGuinnes: I think he was a really cool guy. He was really understanding sometimes, well all the time mostly. But yeah I remember Mikael being a cool guy and he still is. And I wish him all the best.
Kristin: Talk to me about your sessions (as you were older, toward the end of your ABA intervention)- what did they look like?
Cameron McGuinnes: After school most days Mikael or [another behavior technician] would come and we’d do our programs, like [curriculum] and friendship goals. After that I’d take a 30 minute break, then we’d do another session with that sort of stuff in it. Take a shorter break, then we’d do some more stuff then they'd go home.
Kristin: During work was there an option for you to say “No, I don’t want to do this, or I want to do it later?”
Cameron McGuinnes: Yeah, there were times like that. Mikael was really open about that sometimes.
Kristin: Were you able to help structure the session?
Cameron McGuinnes: There were times when they had me do my own data.
Kristin: What did you think of that?
Cameron McGuinnes: It was an extra thing to do for me. It was kind of annoying, but looking back I thought it was helpful. And it is really insightful to see and track your own progress.
Kristin: What kinds of things did Mikael do to make it less boring?
Cameron McGuinnes: He would use Star Wars examples, because I was a big Star Wars nut. I was into Legos and stuff- I used to be a big Lego guy.
Kristin: Clearly you have a bunch of different interests, and you’ve had different interests over time. How do you think ABA helped with that or hindered it? Or had no effect?
Cameron McGuinnes: It hadn’t really had any effect. I know at one point Mikael and I were reading airplane books, and I think that was because… we had books about planes laying around. My family was hugely involved in the…industry.
Kristin: Did he try to find things that you liked and do them and learn about them?
Cameron McGuinnes: Not really, because I just liked stuff that was useless for the future, like Legos, Star Wars, and all that stuff.
Kristin: What are the biggest things ABA “gave you”?
Cameron McGuinnes: ABA gave me good language arts skills and good basic math skills. Like really complicated math, like sometimes algebra. It gave me good basic skills, is really what I would say, and I’m eternally grateful for that.
Kristin: Do you feel like it gave you the skills to do the things you love now?
Cameron McGuinnes: Yeah, I would say yes.
Kristin: I know that you said the goals were valuable and things you could apply to life, but did you have goals that you wanted to work on that were in your program?
Cameron McGuinnes: Again, I was along for the ride, so I didn’t really think about that, that much. I didn’t really think about my future that much.
Kristin: Would you have wanted to have a say? Do you think it would be good to recommend to other people to have clients have a say in what they work on?
Cameron McGuinnes: Yeah, sometimes I thought it would have been nice if I had a say in some of the stuff.
Kristin: If a consultant starts with a new client, should they be listening to things the client wants to work on? Should they be asking the client, what do you want to learn about?
Cameron McGuinnes: Yeah, I think that would be a good question to ask. I’d say go for it.
Kristin: Any last thoughts on things you think people should know or ABA providers should know?
Cameron McGuinnes: If you could just have fun, just relate to the kid. I’d say, be like Mikael, follow the example of Mikael.
Kristin: So, relating to you and being flexible?
Cameron McGuinnes: Yeah, yeah. Overall it was a good experience, and I’m glad I had it, even though I never really had a say and I began it when I was literally two years old and three quarters. I think it really helped.
Kristin: Let’s say there is a BCBA who is going to meet a brand new client and start up an ABA program. What advice would you give that BCBA?
Cameron McGuinnes: Be patient. Be patient and be as nice as you can be because you haven’t met them, and they want to know that you are their friend first and foremost and their teacher, mostly teacher, but you want them to be a friend, too. That’s what I would tell them.
Even the most senior behavior analysts have much to learn from recipients of ABA services. I had three main takeaways from this interview - ones that I want to share in support (not replacement) of Cameron McGuinnes’s words.
First and foremost, the client/practitioner relationship is critical. I’m referring to an actual relationship - one that goes beyond the idea of “establishing rapport” or “pairing.” One that is not only established, but maintained and evolving. This individual struck me when they said they consider their BCBA a “good friend now, and mentor,” years after their program ended. What started off as a more traditional “teacher” and “student” relationship evolved into a friendship and mentorship, in which both the individual and Eliza continue to choose to participate. It is so important that we create a relationship in which we are not giving or directing something “at” our clients, but taking the time to build a relationship of mutual engagement and respect.
Second, we must use values-based practice to design our intervention programs. Our clients need to experience the ways in which their treatment goals directly impact their context/life in a way that supports and promotes their personal values. These goals must be individualized to each unique client and their circumstances. At any given time, a client and/or their guardian should be able to look at the client’s list of programs and directly link them to a value and context in their life.
Sometimes clients or their families want us to come up with treatment goals, are not available for treatment planning, or don’t think they can identify goals that are beneficial long term. It is our job to, 1) make sure they know their voice and values are critical and valuable, and, 2) prioritize identifying their values and selecting goals that move them toward those values.
Third, this individual stated that they benefited from and had a good experience with ABA. They also reported having meaningful and lasting relationships with providers. Based on this report, their program was likely assent-based, incorporated their interests, and included relevant skills. I spent a lot of time thinking about how we can do even better. My final takeaway/thought was - as behavior analysts, how can we incorporate ownership into our programming? By ownership, I mean - how can we ensure the client thinks/feels/knows that they are not just another team member or the one who “gets” the services- but that they are THE team member? The BIG boss, a critical part of the decision making, and a contributor to the intervention? How do we change ABA (as a field or general practice) from being something that is done to or for a client, to something that the client creates?
Most importantly: thank you to this individual for sharing their personal experiences, thoughts, and insight.
Kristin Smith, M.Ed., BCBA, LBA
CentralReach, Instructional Designer
Kristin Smith, M.Ed., BCBA, LBA is a Licensed Behavior Analyst, and Board Certified Behavior Analyst. She began her career in the field of behavior analysis in 2002 and received a master’s degree in Special Education from the University of Washington. Kristin has experience implementing and designing intervention programs across a variety of contexts, with learners ranging in age from 18 months to 40 years. She works with a wide variety of learners, including, but not limited to those with autism, chromosomal deletions, cognitive impairments, learning disabilities, social-emotional and/or behavioral problems, significant challenging behavior, blindness, and children with multiple disabilities. Her areas of expertise include Precision Teaching, instructional design, assessment, and data analysis.
Slocum, T. A., Detrich, R., Wilczynski, S. M., Spencer, T. D., Lewis, T., & Wolfe, K. (2014). The evidence-based practice of applied behavior analysis. The Behavior Analyst, 37(1), 41-56.
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