What is the Secret to a Successful Therapeutic Relationship?
First, The Secret!
The therapeutic techniques used by the therapist are not always directly correlated to the effectiveness of the treatment. Rather, it is the relationship bond that develops between child and therapist that is the determining factor in the successful outcomes.
In ABA Therapy, we use the term “pairing” to describe how the child associates the therapist as being one with an external object of desire. The therapist is the one providing all the fun items for the child. For example, if a child loves Elmo, and the therapist is the person who brings Elmo, the child will associate the therapist with the desired object, Elmo, and the “pairing” process has occurred. This process is of utmost importance not only at the beginning stages of therapy, but throughout further sessions, and is especially important after delayed sessions due to sickness or vacation.
It is easy to observe when pairing has occurred as the child will run toward the therapist rather than away. The child will be excited to play with the toys that the therapist brings; the therapist is a “giver of all good things.” The paired relationship also allows the therapist to have “instructional control” over the therapy session. That is, some form of interaction with the therapist is necessary for the child to access the desired objects. The two concepts “pairing” and “instructional control” work together to establish a successful therapeutic alliance.
If the child runs to hide when the therapist knocks on your door, or if the child needs to be pulled into play, this is a clear indicator that pairing has not occurred—and further, it is an indicator that a successful therapeutic outcome is unlikely. I have witnessed children scream and cry when a therapist walks in the room with a parent pulling them in to sit. This is not a good situation and no benefit can come from such a session. The child must be a willing participant and be fully engaged for success.
Next, Therapists and Parents Must Prepare for Success!
Before the first home session, the therapist should ask the child’s caregiver what the child’s favorite characters and toys are. If Mom says Elmo, then be prepared with a bag full of Elmo stickers, games, dolls, etc. The pairing process should begin immediately.
When entering the home, the therapist should be introduced as a friend, someone who is welcomed into the home. It’s very important that the parent is welcoming and happy to see the therapist and that the child observes this so the child will trust the therapist, feel just as comfortable as the parents, and see the therapist as a “friend”. The child will not see the therapist as a “teacher” who is there to take them away to a room to do some work. It is crucial to note when you come in, the fun begins, not ends.
It’s important that parents turn off the TV 10-15 minutes prior to arrival so you are not having to compete with a potent activity prior to the session. If the TV is still on when the therapist arrives into the house, and Mom shuts off the TV, stating to the child it is time to go into the room and work with your teacher, this creates a negative environment and sets it up for failure. The therapist is then put into a situation taking the child away from something “fun” to make them work. What child wants that in their home for 2 hours?
Keep in mind, many of the ASD children are receiving stimulation from various services throughout the day; occupational therapy, speech therapy, etc. ABA Therapy after school should not be a continuation of more “work.” Rather, it is best when it is perceived as a fun learning environment to achieve optimal results. We want to set our children up for success!
At Achievement Behavior Care, your children are our main concern. And preparing for a successful therapeutic relationship is in the hands of both the ABA therapist and the parents. If you have any questions about how you can help prepare your home or any other questions about the relationship bond, call or shoot us an email at ABC and we’ll be happy to answer.