Practicing with Compassionate Care: A Missing Piece in Behavior Analytic Training
Becoming and practicing behavior analysis is often synonymous with a strong understanding of the technical components of behavior change procedures. Our training often emphasizes skills such as the memorization of terminology until it becomes second nature, evaluating and conducting research, and implementing evidence based treatments. But while our technical skills and competence in these areas is important to our practice, there is an element of our training that is missing. That element is the ability to practice compassionate care. Our jobs as behavior analysts almost always involve working with people and, most frequently, the families of young children. Yet we receive little to no training in how to interact with families.
What is Compassionate Care?
There is no technical definition in behavior analysis to describe compassionate care, but the components involved have been identified. Taylor et al. (2018) describe that compassionate care involves interpersonal skills related to sympathy, empathy, and compassion. They define sympathy as the ability to feel sorry for another but not necessarily with a shared experience. Whereas, empathy involves both perceiving the feelings of others and understanding or being able to experience that emotion. Lastly, compassion involves an action related to empathy, that is meant to alleviate suffering. Generally, compassionate care refers to the ability to put yourself in the shoes of those you are working with and provide meaningful support based on those feelings.
Why is it important?
Although we know behavior analysis can be useful in many different industries and populations, according to the most recent data provided by the BACB, most practitioners work with individuals with autism or other developmental delays. This means that many of us are working with families who are in varying stages of life with a child that has a diagnosis. Whether they just received the diagnosis or have had years of therapies and supports, it can be a major stressor. Ignoring the stresses that our clients and their families are going through can be a huge barrier to providing successful services.
Imagine for a moment, someone comes to your home to help you with your child or family member. As they ask you to describe your concerns you become visibly upset and begin to cry. As you’re crying the professional says “Ok, great thanks for that information. Let’s move on to the next question”. How would that make you feel? Someone is in your home asking you about sensitive issues and they completely dismiss your feelings.
When a family feels disregarded by the person designated to work with their child it can lead to a negative rapport between the professional and family. There is evidence from other fields such as medicine and mental health that compassionate care can lead to increased patient satisfaction, adherence to treatment, enhanced quality of information gathered, and improved clinical outcomes (Taylor et al., 2018). As most of us know, parent involvement is an important part of clinical treatment for children with developmental delays. Our ability to practice compassionate care could greatly improve parents adherence to treatment plans and participation in parent training.
It is also important to remember that our ethics code speaks to the importance of client and caregiver relationships, clear communication, and client preference. A behavior analyst practicing with compassionate care will likely be more successful at adhering closely to those ethical codes.
Lastly, working to practice compassionate care can also potentially improve the overall job satisfaction and happiness of behavior analysts. Even though as behavior analysts we often don’t like to talk about feelings, we cannot discount their relevance to everyday life. Decreasing our stress and improving happiness within the context of our jobs can make us more effective practitioners. As no one functions at their best when they are unhappy and stressed.
How do we put it into practice?
Currently, most behavior analytic training programs do not focus on teaching compassionate care skills. As long as that continues to be true, those of us in the field need to work on these skills on our own. A possible first step is to generally work on improving our own perspective taking skills. It may be helpful to use elements of ACT and mindfulness to achieve this. These therapeutic strategies often focus on acceptance, values, and awareness in the moment. They can also help to work through being presented with aversive stimuli such as an emotional parent.
Another way to begin practicing these skills should be to focus heavily on the individuality of each of your clients. To look at behavior analysis as a set of principles rather than a manualized protocol. In a recent article Callahan et al. (2019) drew a comparison between “traditional behavior techs or analysts” versus what Foxx originally coined as “behavioral artists”. Behavioral artists have a set of interpersonal skills that make them more effective at their job and they generally provide a behavior analytic treatment that looks more televisable. The article lists 7 characteristics that represent a behavioral artist:
- Likes people and is good at establishing rapport
- Has “perceptive sensitivity” and attends to very subtle changes in their client
- Actively avoids failure and see difficult clients as a manageable challenge (genuinely want their clients to succeed)
- Has a sense of humor
- Is optimistic and sees behavior change in a “glass half-full” context
- Is thick-skinned: doesn’t take negative client actions towards themself personally; maintains objectivity and positivity
- Is “self-actualized”: does whatever is necessary (creativity) and appropriate to facilitate and produce positive behavior change
Although it would of course be best if all of these skills came “naturally” to each of us in the field, it does not mean that these skills can not be acquired over time. We should all focus on changing our own behaviors in the target direction of these characteristics. Making our own behavior changes will benefit our clients as well as our own well-being and satisfaction as a behavior analytic practitioner. It will certainly take practice, but we all know that behavior change is possible with the right strategies put into place.
- Callahan, K., Foxx, R. M., Swierczynski, A., Aerts, X., Mehta, S., McComb, M., . . . Sharma, R. (2019). Behavioral artistry: Examining the relationship between the interpersonal skills and effective practice repertoires of applied behavior analysis practitioners. Journal of Autism and Developmental Disorders, 49(9), 3557-3570. https://doi.org/10.1007/s10803-019-04082-1
- LeBlanc, L.A., Taylor, B.A. & Marchese, N.V. (2019). The Training Experiences of Behavior Analysts: Compassionate Care and Therapeutic Relationships with Caregivers. Behavior Analysis in Practice, 13(2), 387–393. https://doi.org./10.1007/s40617-019-00368-z
- Taylor, B. A., LeBlanc, L. A., & Nosik, M. R. (2018). Compassionate care in behavior analytic treatment: Can outcomes be enhanced by attending to relationships with caregivers? Behavior Analysis in Practice, 12(3), 654-666. https://doi.org/10.1007/s40617-018-00289-3