This important article by Taylor et al emphasizes the critical role of compassion, empathy, and strong therapeutic relationships in ABA, advocating for direct training in these interpersonal skills to improve client engagement, satisfaction, and outcomes. It highlights the imperative for ABA practitioners to prioritize ethical practice, client-centered care, and a commitment to continuous improvement and collaboration.
“Compassionate Care in Behavior Analytic Treatment” argues that therapeutic relationship skills, including empathy and compassion, are crucial for effective ABA interventions. The field’s significant growth necessitates identifying factors that lead families to choose and remain engaged in ABA services. Research from other healthcare industries demonstrates a strong correlation between positive clinical relationships and patient satisfaction, adherence, information gathering, and improved clinical outcomes.
Compassionate care is correlated with positive outcomes
“Hojat et al. (2011) found that patients whose physicians were rated high on the Jefferson Scale of Empathy were more likely to have better clinical outcomes related to their management of diabetes.” The article notes that “Although behavior analysts’ empirically derived technical skills will remain essential to ensure client outcomes, those methods do not exist separately from relationships with clients and their caregivers.”
Defining Empathy and Compassion in ABA
The article acknowledges “few behavior-analytic definitions of compassion and empathy.” In looking at other fields we can find more information. For example, sympathy is defined as feeling sorry for another person but not sharing a similar experience of the pain, whereas empathy involves both feeling sorry for the other person and having a shared experience of the pain.
As a practitioner, we don’t presume to have the same exact experiences of pain, but analogous ones that allow us to understand their pain. Compassion, the article notes, takes things a step further by combining empathetic response and then bringing action to relieve the suffering of the other person.
Survey data reported by Taylor et al indicates that parents and caregivers highly value behavior analysts who:
- “make me feel like a valued member of my child’s treatment team” (Mean 4.08, 76.8% Agree).
- “consider my concerns and collaborates with me when developing problem-behavior intervention plans” (Mean 4.16, 78.9% Agree).
- “listened to my concerns about my child” (Mean 4.58, 93.7% Agree).
- Are “optimistic about my child’s capability and potential progress” (Mean 4.23, 87.37% Agree).
- Are “friendly, genuine, and warm” (Mean 4.31, 84.21% Agree).
- “cares about my child” and “cares about the progress of my child” (Mean 4.35 and 4.40 respectively, both over 84% Agree).
Within the field of ABA, clinicians are rarely provided training on a compassionate approach to working with families. Additionally, pressures of time can hamper a clinicians ability to make the time needed to develop this approach. Finally, a clinician may simply not be aware of or reflect on the range of emotions and reactions a caregiver may experience. This lack of skills training and awareness can downgrade the clinicians abilities to work compassionately with families.
For example, a behavior analyst’s internal dialogue (“covert verbal behavior”) can significantly impact the therapeutic relationship. Negative internal thoughts (“Ugh, this parent is never satisfied”) can lead to relationship erosion, whereas empathic statements (“This parent seems upset and is advocating for their child”) can foster collaboration. Mindfulness and self-awareness are crucial for “observing, understanding and regulating my own emotional reactions so I can reliably sustain presence in the face of a patient’s distress—and my own.”
Curriculum Recommendations for Training
The paper advocates for direct training in relationship skills for behavior analysts, drawing from medical field curricula (see, eg, Low et al 2014). Another example may include include the E.M.P.A.T.H.Y. mnemonic (eye contact, muscles of facial expression, posture, affect, tone of voice, hearing the whole patient, your response) (Riess and Kraft-Todd, 2014). Some private ABA providers have developed internal training for their stff.
For example, Alpine Learning Group developed their training “Communicating with Parents: Active and Empathetic Listening” which focuses on empathetic listening and how to engage in potentially difficult conversations.
For more information, please see: Taylor BA, LeBlanc LA, Nosik MR. Compassionate Care in Behavior Analytic Treatment: Can Outcomes be Enhanced by Attending to Relationships with Caregivers? Behav Anal Pract. 2018 Sep 20;12(3):654-666. doi: 10.1007/s40617-018-00289-3. PMID: 31976276; PMCID: PMC6743522.
