behavior therapy

Appearing to enjoy behavior modificiation is not meaningful

One common response to criticism of ABA is to claim that people subjected to it enjoy it:

  • “My child loves his therapist and asks to go to sessions!”
  • “All of my clients smile and have fun!”
  • “My ABA is play based!”

What people forget is that affect is a set of behaviors, and that behavior modification methods work as well on affective behaviors as they do on anything else:

  • You can reinforce people to look happy
  • You can reinforce people to praise therapy
  • It doesn’t have to be an explicit part of the behavior plan to happen
  • And it can keep happening even after you fade direct prompts or direct intentional reinforcers

ABA programs give the therapist massive power over the person. That power in itself can cause people to look happy, through a more subtle reinforcement mechanism than takes place on a behavior plan:

  • If you have power over someone in the way that behavior therapists do, they’re going to be highly motivated to please you
  • If they figure out that you want to believe that they are happy, they are very likely to act like they are
  • If you treat them better when they display the affect you want or praise you, they’re likely to act happy.
  • It doesn’t mean they’re actually happy
  • Or that what you’re doing is good for them

(Also, affect often is an explicit part of someone’s behavior plan. It is not at all uncommon for ABA programs to involve actively ignoring distress and withholding attention and rewards until someone looks happy. It is not at all uncommon for ABA programs to involve teaching people to smile, to hug, or to otherwise do things that would out-of-context indicate happiness, enjoyment, or affection. It doesn’t have the same meaning if it’s prompted or trained.)

Also, programs based on positive reinforcement involving controlling someone’s access to stuff they care about:

  • The first step in a program based on positive reinforcement is to find out what someone most enjoys or cares about
  • (This is called a preference assessment or a reinforcement inventory. Here’s an example.)
  • And then making sure they have no access (or limited access) to those things outside of sessions or other situations in which someone is actively reinforcing them to do something
  • Of course if someone’s only access to everything important to them happens in sessions they will ask for sessions
  • That doesn’t mean they like the fact that someone has that level of power over them
  • (No one likes being manipulated that way.)
  • That doesn’t mean they like the things that the therapist makes them do
  • That doesn’t mean the power dynamic is harmless
  • That doesn’t mean ABA is a good approach to teaching

People who can’t say no, can’t say yes meaningfully. Looking happy isn’t meaningful if you’re rewarded for affecting happiness and punished for looking visibly distressed. Making the best of a bad situation isn’t consent.

If you want me to believe you're a good behaviorist

Content note: this post is about ABA (applied behavior analysis), and what it would take for a behaviorist to be considered ethical. Proceed with caution.

When self advocates talk about the problems with ABA, a lot of behavior therapists say things along the lines of “that’s not real ABA; ABA is a science, not a particular method.” Or “that’s just some bad practitioners.” They will say this even when self-advocates criticize things that are routine practices in ABA, and even when they are in fact explicitly advocated in the BACB standard of practice for behavior therapy.

If you want people to believe that you’re not the kind of behaviorist they’re criticizing, acknowledge that most behaviorists are, and that they have completely legitimate reasons not to trust you.

For instance:

“What kind of staff are you?” she continued. I was unsure of what she meant so I asked her to clarify. “Well, do you work in a group home or an office?” I told her that I worked in an office and I was a behavior therapist. I must admit that I said the behavior therapist part with some pride. She stared at me, “What do you do?” she asked in a very measured tone. “I’m a behavior therapist. I work with people who have problems.”

That was it. She was angry. “You shouldn’t be here. You lock people in little rooms. You shouldn’t be here.” Both her anger and her words took me aback and before I could answer my friend spoke up. “Maybe it’s good that he is here then. He may learn something from the movie that will help him understand people better.” She agreed and the two of them discussed my betterment. When others started to arrive she left us to help people find seats.

Sitting through that was bad enough but sitting next to someone who was bound to feel smug for the next few hours was nearly intolerable. At the reception afterwards she approached us again and asked if I had liked the movie and I assured her I had. She wanted to know if I had learned anything and I told her that I did. I learned that it was good to be challenged about what I do from the people I do it to. Even though I had not locked anyone in a little room for some time, I knew that I had used time out and other procedures like it. I knew that I would remember her for a long time, but especially whenever I wrote a program to manage someone’s behavior.“

— Dave Hingsburger, “i to I: Self Concept and People With Developmental Disabilities”
Note here, that he didn’t respond with anger and say "I don’t lock people into little rooms! I’m not that kind of behaviorist! How dare you judge me like that?!”. He listened to what she said, acknowledged that she had good reasons to say it, and realized that this should give him serious pause for how he treated people in behavior therapy. He didn’t assume that no longer doing one particular abusive practice meant that he was immune to that kind of criticism.
If you are a behavior therapist, especially if you are a BCBA, a lot of people have very good reasons not to trust you. Even if you’ve never personally locked someone in a little room, your colleagues still do and still retain good professional standing. Even if you’ve never written a program to extinguish stimming, your colleagues still routinely do so, and your professional association’s guidelines for practice in autism therapy explicitly encourage this.
 
You can’t rely on the positive reputation of behaviorism for legitimacy, and at the same time expect to be immune from the negative reputation of behaviorism that comes from the horrific abuses that have been and still are committed by behaviorists. 
If you choose to be a behaviorist, particularly if you chose to be a BACB cerified BCBA, and particularly if you call what you are doing ABA therapy - you are not entitled to any benefit of the doubt. You’ve got a hell of a lot of evil weighing you down.
 
You are the product of a discipline that locks people in little rooms as punishment, and did so even more frequently in the past. It’s not against the current ethical standards of practice.
Quiet hands is still practiced. So is shocking people. The current standard of practice for autism therapy still calls for 25-40 hours a week, even for young children. It still calls for treating stimming as a target behavior for elimination. 
  
Don’t expect us to be deeply impressed that you don’t personally torture anyone. The fact that it needs to be said, means that you have to work hard at proving yourself if you want to be trusted. And don’t expect people to believe you right away either, because a lot of people who say they don’t torture people really just mean that they do it in subtle ways, or that they do it only as a last resort. Self advocates have a lot of really good reasons to doubt that you’re an exception. If you want to be seen as one, acknowledge that you’re unusual in that regard and that they have every reason to assume you’re not trustworthy.
     
If you want to distance yourself from abusive behaviorism, do it all the way. Don’t wait for self advocates to associate you with abusive behaviorism. Distance yourself from abusive behaviorism even when doing so harms your professional reputation (and it will, because abuse is the norm). Acknowledge that self advocates and others have every reason not to trust you. Horrible things have been done by behaviorists for a long time. Horrible things are still being done.
Maybe you don’t do any of that. Maybe you don’t torture anyone or teach them antiskills. Maybe you don’t insist on a number of hours that prevents someone from having any down time, non-behaviorist education, or social relationships.
 
Maybe your teacher doesn’t do those things either. But someone who taught their teacher, did. And someone you and your teacher regard as a collegue in good standing, still does. 
  
The fact that you personally don’t torture anyone, even if true, does not undo the tremendous evil in behaviorist culture, theory, and practice. It does not absolve you of the responsibility of dealing with it, either.
Don’t expect the benefit of the doubt from those of us who are from communities that have been harmed (and are still being harmed) by behaviorism. You don’t deserve that as a default, no matter how good you are personally. Any respect you get for your professional work is something you have to earn personally, and you’re starting with a debt.

A basic problem with ABA

Content note: This post is about ABA and abuse culture within ABA. Proceed with caution.

Applied Behavior Analysis and other forms of behaviorism combine these things in a disastrous way:

  • Behavior analysts with highly idealized notions of What People Should Do and How People Learn
  • Highly developed behavior modification techniques that can be effectively used to make people do complex things at the direction of the therapist
  • Disabled people who are socially devalued to the point that behavior analysts are given free rein to modify their behavior
  • A hierarchy of behaviorists, in which lower level behaviorists have to rigidly follow the plans of those above them in the hierarchy (and take data proving that they have done so) regardless of what the person they’re doing it to communicates

This is present at the heart of ABA culture. Behavior analysts have a notion of how they’d like the world to be, and they use powerless people with disabilities as props to make the world look that way.

Some BCBAs mean well; some don’t. Most BCBAs probably believe that they are helping vulnerable people to learn in the only way possible. Some BCBAs even teach some of their students useful skills using the principles of behavior analysis. None of that solves the core problem in behaviorist culture. The combination of ideology and power is dangerous, no matter how well-meaning those who wield it are.

All behavior therapists have far, far more power to control their students than anyone should ever have. Complex effective behavior modification techniques create a dangerous level of power in themselves. In a better world, this could be moderated by a professional culture that acknowledged the danger in this power and had rigorous standards about using it in consensual ways. Behaviorist professional culture could be like that, but it isn’t.

All of them are part of a professional culture that constantly gives them the message that the level of power they have over their students is necessary and important, and that it’s the only possible way their student can be ok in any way. (They may even be getting the message that they don’t have enough power over their students, and taught to lament the fact that they don’t have enough power to be truly effective.)

It’s possible to use behaviorist principles to teach someone how to dress themself. It’s just as possible to use the same principles to teach someone that she must wear only feminine clothing or that he must never wear a skirt. And that’s an easy line to cross without even realizing it. Behaviorists have highly developed techniques for controlling behavior. They don’t have highly developed techniques for *refraining* from controlling behavior, or being ethical about *which* behavior they’re controlling. They have vaguely defined professional ethics about not hurting people, but that’s nowhere near good enough.  

This problem plays out in any number of ways. 

It’s like – a hydra. Some of the heads are things like electric shock and starvation. And other heads are taking away everything a victim loves and making them earn it back with compliance. Or training children that stimming and other forms of autistic body language are wrong. Or forcing children to enact the therapist’s stereotypes of appropriate play.

Some of the heads are much subtler. Some of them don’t have words yet. Any head of the hydra, by itself, represents a serious violation. None of them is the entire problem.

Any BCBA can cut some of those heads off the hydra, and say “Not all BCBAs are like that!”. Or “nobody uses electric shock anymore; that was in the 70s!” or “My ABA is play-based” or “I give kids frequent breaks; no 2-hour sessions of DTT here,” or “I would never extinguish stimming.”

But cutting off some of the obvious heads, or even all of the heads that self advocates have found words for, doesn’t solve the basic problems.

The hydra is still there even if all of the named heads are cut off. Cut off all of the heads anyone has found words for, and you still have the basic problem of people with extreme levels of power to modify the behavior of people with disabilities in arbitrary ways. Behaviorism will never be ok until that problem is solved.

It might be possible to be a behaviorist without being part of the hydra. If anyone’s doing it, it’s Dave Hingsburger and some of his students. But people who want to use principles of behavior therapy in a respectful (or even just non-abusive) way face a tremendous barrier to entry in the field. In order to become a BCBA high up enough in the hierarchy to write programs following your values, you have to spend a lot of hours doing entry-level behavior therapy works. That means following someone else’s program. That means doing a lot of harm to innocent people with disabilities, unless you can somehow find a supervisor who goes against the entire culture of behaviorism to treat people with disabilities as fully human.

tl;dr Behaviorism has some potentially legitimate applications, but the professional culture of behaviorism is deeply committed to abuse of power. It’s nearly impossible to be a behavior therapist without doing profoundly degrading and damaging things to people who deserve better. (And if you think you’re doing so, I’d like to hear about how you’re managing that).