ACT for Behavior Analysts: Interview with Tom Szabo, PhD, BCBA-D

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This is an exciting time for behavior analysts. First of all, why are psychotherapy tools like acceptance and commitment training (ACT) taboo in the behavior analysis community?

Applied behavior analysts (ABA) do not conduct psychotherapy. It’s one of many kinds of work that are not within our scope of practice. Broadly speaking, psychotherapy is talk therapy that aims at helping people flourish in the context of emotional problems.

ABA is interested in helping people flourish. But in contrast to talk therapy approaches, ABA scope of practice involves direct intervention upon socially significant behavior that can be observed, measured, and the analysis of which can be arranged – within clinical work – to rule out the possible influence of other variables.

The procedures are described precisely enough that others will obtain the same, strong results that can be traced back to basic principles and are sustainable over time and in new environments. One important distinction is that ABA practitioners don’t target private behavior such as thinking, emotion, and remembering for intervention – whereas most psychotherapies do.

But as you say, it’s an exciting time for behavior analysts because some are beginning to see the usefulness of strategies first developed in psychotherapy. For behavior analysts, first and foremost, the goal is to change overt behavior that is socially important. Nothing in that says we can’t address emotions, sensations, thoughts, and memories. But we don’t target these for change, so we don’t try to measure them. Instead, we might address them as part of the antecedent context in which behavior occurs.

How are ACT tools helpful for supporting parents of children with autism?

Kids with autism, even those at the high end of the spectrum, need a lot of help from others at learning effective behavior that’s sensitive to the context. Their chances of learning are best when parents offer consistent, contingent learning opportunities.

Learning how to do this as a parent is tough, and doing it with a resistant kiddo is even harder. It’s painful. All of that is on top of mourning the loss of the kid you thought you’d have, struggling to keep the finances together, making a parenting partnership work in the context of escalating medical bills and work obligations. Parents of kids with special needs feel isolated, ashamed, abandoned, and betrayed. It’s no wonder that they contact the most reinforcement by just giving their kids what the kids want.

Many of us focus on ways to increase parent engagement in ABA sessions when we’re there and when we’ve left for the weekend. The problem is we don’t control the reinforcers available to parents for avoiding this work when we’re not around, and there are plenty of opportunities for negative reinforcement by avoiding the work even when we’re right there in the room. How do you help parents become effective contingency managers? Again, it’s a question of time. When there is little money in prior authorizations for parent training, then extended modeling, role-play, rehearsal, feedback, goal-setting and fading strategies may be impractical.

An alternative is to do some very fast-acting ACT work in session. Train parents to do things that transform the function of private events and to self-monitor their allocation of time. Measure the duration of parent engagement and rate of child behavior changes. Ask parents to record their sessions with their kids when you’re not there. You’ll know pretty fast if the behavioral flexibility training (aka ACT) work you did was effective or not.

What are some of the unique challenges of being a behavior analyst, and how does ACT help you face those challenges?

Before I graduated, I was convinced that I was an imposter and was soon to be discovered. My world was about to come crashing down on top of me. The fact that I was training people to use ACT in their lives only added to the verbal traps I was digging for myself. After all, “I’m a behavior analyst, not a psychotherapist, so surely, I’m out of my depth,” I kept saying to myself.

I still go there. I still fret the night before a training. When I’m going to try out new things, I want to duck and cover. And in the past, I did just that a few times. The cost was more than “my vitality” or whatever else some people talk about. For me, the cost was that I darn near lost my life.

The difference is that now, I show up: frail, wobbly kneed, mistake-making me. I show up.

The difference is everything. I can talk about it. And it makes other people feel at ease, because I’m not the only one in the room who’s experienced that. Every. One. Of. Us. Does. When I show up with service as my value, I help someone in the room. For me, that’s just enough.

How would you like to see the scope of work evolve in behavior analysis?

I’d like ABA to expand inside our current scope of practice to use strategies that come from outside our own labs and clinics. The bottom line is that if ABA is going to be relevant in the 21st century, we need to address many more real-world issues than those faced by parents of kids with autism and other intellectual and developmental disabilities.

What about behavior in conditions of poverty, recruitment into gangs and terrorist cells, or intimate partner, gender-based violence? Strategies and tactics that worked in the basic labs, clinics, and school settings may need to be retooled for new environments. This is where some ACT strategies can be quite powerful – again with a focus on socially significant, observable, measurable behavior.

See also: Positive and Negative Reinforcement in Context: A Look Inside Relational Frame Theory

Will you share a success story with us?!

A few years back, I was asked to help teach male therapists in Sierra Leone working with men who had committed acts of intimate partner, gender-based violence. I didn’t know if I could do anything to help. There are virtually no ABA models in this area. So, I got a bit of supervision and set out to meet with therapists. I ended up meeting therapists who had hurt their own domestic partners and needed help.

Working with couples online was a trip. Again, I had no clue what to do. So, I got some more supervision and set out to learn while doing. And I got results. So I wrote a grant and got funding to travel to Sierra Leone and conduct a multiple baseline study across couples, primarily targeting within-session microaggression (which I could see) and between-session physical aggression (which I could not see, but I found some ways to get a measure of inter-observer reliability).

The results were way better than I had imagined. By the third session, couples looked and behaved differently. And, they were coming in with stories about how neighbors and family members were asking them for help in their relationships. Later, tribal chiefs started asking for a larger roll-out of the intervention, which we called DARE to Connect.

So, now we’re writing a larger grant for a train-the-trainer study. We want to know what are necessary and sufficient conditions for becoming a competent DARE trainer. A manual? A manual plus in-person instruction from a couple who has gone through the DARE to Connect intervention? Or a manual plus instruction from a PhD ACT trainer? We will see.

This is the most exciting work I’ve ever done. I’m headed back to Sierra Leone in a few weeks to write the manual with folks who completed the pilot study with me. Wish me luck!

Tom Szabo, PhD, BCBA-D, is a faculty member in the Hybrid Master’s Degree Program for Professional Behavior Analysis at the Florida Institute of Technology, site director at the Center for Autism and Related Disorders, an internationally recognized ACT trainer, a practicing Board Certified Behavior Analyst, and a graduate of the University of Nevada, Reno, where he studied under Steven C. Hayes and W. Larry Williams. Over the last 10 years, Tom has focused his practice on teaching people ways to ignite behavioral flexibility in their personal lives and with others in clinical practice, schools, board rooms, shop floors, and community centers. 

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