Not All Therapists Are Created Equal

Posted by Ashley, Special Educator

This seems to be a regular topic of conversation with many of the families we work with.  I cannot begin to count the number of parents who have expressed dissatisfaction with one or more of their child’s home-based therapists (e.g. ABA, Special Instruction, Occupational Therapy, Physical Therapy, Speech and Language Therapy).  In many cases, parents come to us explaining that they feel that something is not quite right, but also doubt their feelings and intuition.  Some parents feel confident in their instincts, but feel unsure of what to do next.  Especially in the field of Early Intervention, when families are just beginning to navigate this overwhelming world of special education, many parents do not feel that they have the knowledge or experience necessary to evaluate a therapist’s skills.  I hope the information provided here will offer guidance to any parents who find themselves in this situation.

My first piece of advice to parents is always the same:  trust your instincts.

You are an expert on your child.  You were his/her first teacher and you will always be the most important one.  You know your child best and if you do not feel comfortable with a therapist then you should trust those instincts.  You have a right to feel comfortable with every professional who works with your family.  To quote one of our amazing parents, not all therapists are created equal.  Professionals in the field of special education may have very different levels of experience, education, and skill.  The same qualifications on paper may not equal the same qualifications in practice.  The unfortunate truth is that there are some bad therapists out there, and some therapists who terribly misrepresent the field of Applied Behavior Analysis (ABA).  There are also some acceptable therapists out there who just may not be right for your child.  Not every therapist you encounter will be a good match for your family's goals.  Theoretically, any skilled educator should be able to successfully work with any family, but in the real world that is not always the case.  If you find that you do not feel comfortable with a therapist, know that you have the right to request someone new.

So how do you make this decision?

As I have already mentioned, your parental instincts are often the first indicator.  However, it is also important to balance this with the knowledge that your child’s intervention may not feel or look perfect right away.  Especially when we are discussing early intervention with very young children, this may be your child’s first educational experience.  Sometimes this can be a difficult transition for everyone involved.  It may take time for your child to build a positive relationship with his/her therapist and to feel comfortable separating from you.  It may take time for the therapist to accurately assess your child’s personality, strengths, needs, and learning style.  It may take time for your child to adjust to different demands, expectations, people, or environments.  It may take time for the therapist to learn how to best serve your family.  It may take time for you, as a parent, to entrust your beautiful child with someone new.  And, it will likely take time for you to see change and progress.  However, if you have a good therapist, these things will happen in time. 

How much time is sufficient?

Unfortunately there is no one-size-fits-all answer for this.  In general, if you have given your child’s therapist at least a month of regular services (i.e. several sessions per week) and are not seeing progress in any of these areas, you may have cause for concern.  At this point, I recommend that you meet with your therapist and/or your therapist’s supervisor to discuss potential resolutions.  An open conversation with your child's therapist may be very productive.  Your concerns may also be resolved by having your therapist receive additional training and supervision.  Of course, depending on how strong your feelings are and the level of your concern, you do not need to wait this long to take action.  If you suspect that your child’s therapist is engaging in unethical behavior or that your child’s well being is in danger, please take immediate action.  Remember that you are the most important member of your child’s intervention team—you have the right to demand improvement, or to demand a change. 

How do you know when a change is needed?

In cases when you are unsure of what to expect from your child’s therapist or how to evaluate him/her, I hope the information below will help to guide your observations and decisions.  Many of these points may also apply to therapists from disciplines other than ABA.  Here you will find a basic list of skills, qualities, and/or outcomes that you can expect from a good ABA therapist:

• Positive Rapport: Your child’s therapist should establish trusting and positive relationships with both you and your child (in ABA, we often call this “pairing”) [more information].  Pairing is a key element in effective teaching.
• Professional Conduct:  Your child’s therapist should conduct himself/herself in a way that is professional—he/she should be punctual, respectful, knowledgeable, and appropriate.  Your child's therapist should also interact with your child in a way that is professional.  Therapists must remain calm, neutral, and level-headed in the face of challenging situations or interfering behavior.
• Skills Assessment: Your child’s therapist should have an accurate understanding of your child’s skills, strengths, and areas of need, based on objective data and assessment.
• Instructional Plan:  Your child’s therapist should have a plan for how he/she will educate and support your child.  The therapist should be able to share this plan with you and justify it.  The plan should be based on behavioral learning principles. (Pointer: your therapist should be using words like, "reinforcement", "shaping", "modeling", "chaining", "function", etc.).  Your values, goals, and opinions as a parent should also be included in the development of this plan.
• Data Collection and Analysis:  Your child’s therapist should be utilizing a system of data collection and should be making decisions based on that data.  Your child’s data should be available to you at any time.  In the field of ABA, we believe in making "data-driven decisions". If your ABA therapist is not recording and analyzing data, then he/she is not providing true ABA services.  If you are concerned about your child's progress, consider asking to see the therapist's data.
• Intervention Strategies:  Your child’s therapist should identify areas of need in a timely fashion and implement appropriate interventions to continue your child’s progress.  Sometimes your child or therapist may hit a bump in the road and may stop progressing in one or more areas.  This happens sometimes.  Your therapist should be tracking your child's progress in order to identify when and if this happens, then should be making adjustments to instruction to help your child move forward.  There is a famous saying in education: "if they are not learning the way we teach, then we must teach the way they learn."  This also applies to effective interventions involving interfering behavior.  Your ABA therapist should be knowledgeable in the principles of Applied Behavior Analysis and should apply those principles accordingly. 
• Collaboration:  Your child’s therapists should function as a team, with you and with each other. Team work and consistency are important to your child's success.  Your child's therapists should recognize that you are the leader of your child's intervention team, and should treat you as such.  You should be invited to participate in your child's session and should receive advice and instruction from your child's therapist.  Your child's therapist should be teaching you how to become your child's therapist.
• Communication:  Your child’s therapist should communicate with you and other therapists/educators on a regular basis.  This communication may occur through a notebook, phone calls, face-to-face meetings, or e-mail.  Your child’s therapist should be able to effectively communicate what he/she is working on with your child.  The therapist's communication with you, your child, and other professionals should always be respectful.
• Family Support:  Your child’s therapist is there to assist both you and your child, especially during the years of Early Intervention.  The therapist should be sharing ideas, information, and strategies with you so that you can carry over the skills he/she is targeting.  The therapist should also be hearing and implementing the goals that are important to you.  Again, your child's therapist should view you as a valuable team member.
• Willingness and Desire to Learn:  Your child's therapist should be open minded and willing to learn.  Good therapists should always be interested in improving their skills.  Good therapists are aware of what they know and what they do not. 
• Progress:  Your child’s therapist should be achieving progress.  Every child is a unique individual who may have different strengths and needs, and who may learn in a different way or at a different pace, but learning should be occurring.  If your therapist is appropriately applying principles of ABA, then behavioral change should occur.  If learning is not happening, then behavioral principles are not being used appropriately.
• Evidence-Based Practices:  Your child’s therapist should be utilizing evidence-based practices.  This means that he/she should be able to provide you with legitimate information supporting the practices being used to teach your child.  If your child's therapist is utilizing true ABA principles, then there should be plenty of evidence supporting them.

This, of course, is not a comprehensive list of all the qualities you will find in an ideal ABA therapist, but it does include some of the most basic ones.  I hope that this will offer you guidance in evaluating your child’s therapists and making informed decisions for your family.  Always remember that you are your child’s most valuable teacher and advocate…and that there is great power in trusting your instincts!