Advertisement

Behavior Analysis in Practice

, Volume 12, Issue 3, pp 654–666 | Cite as

Compassionate Care in Behavior Analytic Treatment: Can Outcomes be Enhanced by Attending to Relationships with Caregivers?

  • Bridget A. TaylorEmail author
  • Linda A. LeBlanc
  • Melissa R. Nosik
Discussion and Review Paper

Abstract

The practice of behavior analysis has become a booming industry with growth to over 30,000 Board Certified Behavior Analysts (BCBAs) who primarily work with children with autism and their families. Most of these BCBAs are relatively novice and have likely been trained in graduate programs that focus primarily on conceptual and technical skills. Successfully working with families of children with autism, however, requires critical interpersonal skills, as well as technical skills. As practitioners strive to respond efficiently and compassionately to distressed families of children with autism, technical skills must be balanced with fluency in relationship-building skills that strengthen the commitment to treatment. The current article provides an outline of important therapeutic relationship skills that should inform the repertoire of any practicing behavior analyst, strategies to cultivate and enhance those skills, and discussion of the potential effects of relationship variables on treatment outcomes.

Keywords

Autism Collaboration Compassion Empathy Family Parents Perspective taking Therapeutic relationship 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

The participants in the survey were not identifiable and provided consent by completing the survey.

References

  1. About Compassion Cultivation Training. (2016, December 7). Retrieved from http://ccare.standford.edu/education/about-compassion-cultivation-training-cct/
  2. Allen, K. D., & Warzak, W. J. (2000). The problem of parental nonadherence in clinical behavior analysis: effective treatment is not enough. Journal of Applied Behavior Analysis, 33, 373–391.  https://doi.org/10.1901/jaba.2000.33-373 CrossRefGoogle Scholar
  3. Ambady, N., Koo, J., Roshenthal, R., & Winograd, C. (2002). Physical therapists’ nonverbal communication predicts geriatric patients’ health outcomes. Psychology and Aging, 17(3), 443–452.CrossRefGoogle Scholar
  4. Aragon, K. (2016). When emotions fill the room: How to use empathic statements to move a conversation forward. Retrieved from http://www.theschwartzcenter.org/supporting-caregivers/educational-programs/past-compassion-action-webinars/2016-compassion-in-action-webinars/
  5. Armstrong, K. (2010). Twelve steps to a compassionate life. New York, NY: Anchor Books.Google Scholar
  6. Association for Patient Experience. (n.d.). Retrieved from https://www.patient-experience.org/Home.aspx
  7. Autism Speaks. (2017). State priorities. Retrieved from www.autismspeaks.org/state-initiatives
  8. Baker, C. J., & LeBlanc, L. A. (2011). Acceptability of interventions for aggressive behavior in long-term care settings: comparing ratings and hierarchical selection. Behavior Therapy, 42, 30–41.  https://doi.org/10.1016/j.beth.2010.04.005 CrossRefGoogle Scholar
  9. Barnes-Holmes, Y., Foody, M., Barnes-Holmes, D., & McHugh, L. (2013). Advances in research on deictic relations and perspective-taking. In S. Dymond & B. Roche (Eds.), Advances in relational frame theory: Research and application (pp. 127–148). Oakland, CA: Context Press/New Harbinger.Google Scholar
  10. Behavior Analyst Certification Board. (2014). BCBA/BCaBA task list (4th ed.). Retrieved from https://www.bacb.com/wp-content/uploads/2017/09/160101-BCBA-BCaBA-task-list-fourth-edition-english.pdf
  11. Behavior Analyst Certification Board. (2016). Professional and ethical compliance code for behavior analysts. Retrieved from https://www.bacb.com/wp-content/uploads/2017/09/170706-compliance-code-english.pdf
  12. Behavior Analyst Certification Board. (2018). A summary of ethical violations by BACB certificants: 2016–2017. Littleton, CO: Author.Google Scholar
  13. Behavior Analyst Certification Board. (n.d.). BACB certificant data. Retrieved from https://www.bacb.com/BACB-certificant-data
  14. Carr, J. E., & Nosik, M. R. (2016). Professional credentialing of practicing behavior analysts. Policy Insights From the Behavioral and Brain Sciences, 4, 3–8.  https://doi.org/10.1177/2372732216685861.CrossRefGoogle Scholar
  15. Center for Excellence in Healthcare Communication. (n.d.). The R.E.D.E.℠ model. Retrieved from http://clevelandclinicexperiencepartners.com/training-professional-development/rede-to-communicate
  16. Chaitoff, A., Sun, B., Windover, A., Bokar, D., Featherall, J., Rothberg, M. B., & Misra-Hebert, A. D. (2017). Association between physician empathy, physician characteristics, and standardized measures of patient experiences. Academic Medicine, 2, 1464–1471.  https://doi.org/10.1097/ACM.0000000000001671 CrossRefGoogle Scholar
  17. Critchfield, T. S., Doepke, K. J., Epting, K. L., Becirevic, A., Reed, D. D., Fienup, D. M., et al. (2017). Normative emotional responses to behavior analysis jargon or how not to use words to win friends and influence people. Behavior Analysis in Practice, 10, 97–106.  https://doi.org/10.1007/s40617-016-0161-9 CrossRefGoogle Scholar
  18. Croen, L. A., Shankute, N., Davignon, M., Massolo, M., & Yoshida, C. (2017). Demographic and clinical characteristics associated with engagement in behavioral health treatment among children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 47(1), 3347–3357.  https://doi.org/10.1007/s10803-017-3247-5 CrossRefGoogle Scholar
  19. Derksen, F., Bensing, J., & Lagro-Janssen, A. (2013). Effectiveness of empathy in general practice: a systematic review. British Journal of General Practice, 63(606), 76–84.  https://doi.org/10.3399/bjgp13X660814 CrossRefGoogle Scholar
  20. Di Blasi, Z., Harkness, E., Edzard, E., Georgiou, A., & Kleijnen, J. (2001). Influence of context effects of health outcomes: a systematic review. The Lancet, 357, 757–762.CrossRefGoogle Scholar
  21. Empathetics Neuroscience of Emotions. (n.d.). Retrieved from http://empathetics.com/
  22. Epstein, R. (2017). Attending: Medicine, mindfulness, and humanity. New York, NY: Scribner.Google Scholar
  23. Fiske, K. E. (2017). Autism and the family: Understanding and supporting parents and siblings. New York, NY: Norton.Google Scholar
  24. Fogarty, L. A., Curbow, B. A., Wingard, J. R., McDonnell, K., & Somerfield, M. R. (1999). Can 40 seconds of compassion reduce patient anxiety? Journal of Clinical Oncology, 17(1), 371–379.  https://doi.org/10.1200/JCO.1999.17.1.371 CrossRefGoogle Scholar
  25. Fong, E., Catagnus, R., Brodhead, T. M., Quigley, S., & Field, S. (2016). Developing the cultural awareness skills of behavior analysts. Behavior Analysis in Practice, 9, 84–94.  https://doi.org/10.1007/s40617-016-0111-6 CrossRefGoogle Scholar
  26. Friman, P. C., Hayes, S. C., & Wilson, K. G. (1998). Why behavior analysts should study emotion: the example of anxiety. Journal of Applied Behavior Analysis, 31, 137–156.  https://doi.org/10.1901/jaba.1998.31-137 CrossRefGoogle Scholar
  27. Fuks, A. (2016, April 20). Active listening: Lost art or learnable skill? Retrieved from http://www.theschwartzcenter.org/past-webinars/active-listening-lost-art-or-learnable-skill-presented-by-abraham-fuks-md/
  28. Goetz, J. L., & Simon-Thomas, E. (2017). The landscape of compassion: Definitions and scientific approaches. In E. M. Seppala, E. Simon-Thomas, S. L. Brown, M. C. Worline, C. D. Cameron, & J. R. Doty (Eds.), The Oxford handbook of compassion science (pp. 3–17). New York, NY: Oxford University Press.Google Scholar
  29. Gould, E., Tarbox, J., & Coyne, L. (2017). Evaluating the effects of acceptance and commitment training on the overt behavior of parents of children with autism. Journal of Contextual Behavioral Science, 7(1), 81–88.  https://doi.org/10.1016/j.jcbs.2017.06.003 Google Scholar
  30. Gould, E., Tarbox, J., O’Hora, D., Noone, S., & Bergstrom, R. (2011). Teaching children with autism a basic component skill of perspective-taking. Behavioral Interventions, 26, 50–66.  https://doi.org/10.1002/bin.320 CrossRefGoogle Scholar
  31. Halpern, J. (2001). From detached concern to empathy: Humanizing medical practice. New York, NY: Oxford University Press.CrossRefGoogle Scholar
  32. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford.Google Scholar
  33. Hojat, M., Louis, D., Markham, F., Wender, R., Rabinowitz, C., & Gonnella, J. (2011). Physician’s empathy and clinical outcomes for diabetic patients. Academic Medicine, 86, 359–364.  https://doi.org/10.1097/ACM.0b013e3182086fe1 CrossRefGoogle Scholar
  34. Karver, M. S., Handelsman, J. B., Fields, S., & Bickman, L. (2006). Meta-analysis of therapeutic relationship variables in youth and family therapy: the evidence for different relationship variables in the child and adolescent treatment outcome literature. Clinical Psychology Review, 26, 50–65.  https://doi.org/10.1016/j.cpr.2005.09.001 CrossRefGoogle Scholar
  35. Kelley, J. M., Kraft-Todd, G., Schapira, L., Kossowsky, J., & Riess, H. (2014). The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PLoS One, 9(4), e94207.  https://doi.org/10.1371/journal.pone.0094207 CrossRefGoogle Scholar
  36. Kirby, J. N., Tellegen, C. L., & Steindl, S. R. (2017). A meta-analysis of compassion-based interventions: current state of knowledge and future directions. Behavior Therapy, 48(6), 778–792.  https://doi.org/10.1016/j.beth.2017.06.003 CrossRefGoogle Scholar
  37. Kraft-Todd, G. T., Reinero, D. A., Kelley, J. M., Heberlein, A. S., Baer, L., & Riess, H. (2017). Empathic nonverbal behavior increases ratings of both warmth and competence in a medical context. PLoS One, 12(5), e0177758.  https://doi.org/10.1371/journal.pone.0177758 CrossRefGoogle Scholar
  38. Kukk, C. L. (2017). The compassionate achiever. New York, NY: HarperCollins.Google Scholar
  39. LeBlanc, L. A., Coates, A. M., Daneshvar, S., Charlop-Christy, M. H., Morris, C., & Lancaster, B. M. (2003). Using video modeling and reinforcement to teach perspective-taking skills to children with autism. Journal of Applied Behavior Analysis, 36, 253–257.  https://doi.org/10.1901/jaba.2003.36-253 CrossRefGoogle Scholar
  40. Lown, B. A. (2016). A social neuroscience-informed model for teaching and practicing compassion in health care. Medical Education, 50, 332–342.  https://doi.org/10.1111/medu.12926 CrossRefGoogle Scholar
  41. Lown, B. A., McIntosh, S., McGuinn, K., Aschenbrener, C., DeWitt, B. B., Chou, C., et al. (2014). Triple C conference framework tables. Retrieved from http://www.theschwartzcenter.org/media/Triple-C-Conference-Framework-Tables_FINAL.pdf
  42. Lugo, A. M., King, M. L., Lamphere, J. C., & Paige, M. E. (2017). Developing procedures to improve therapist-child rapport in early intervention. Behavior Analysis in Practice, 10, 395–401.  https://doi.org/10.1007/s40617-016-0165-5 CrossRefGoogle Scholar
  43. Lutz, H., Patterson, B., & Klein, J. (2012). Coping with autism: a journey toward adaptation. Journal of Pediatric Nursing, 27, 206–213.  https://doi.org/10.1016/j.pedn.2011.03.013 CrossRefGoogle Scholar
  44. Massachusetts General Hospital. (n.d.). Empathy and relational science program. Retrieved from http://www.massgeneral.org/psychiatry/research/empathy_home.aspx
  45. McClelland, L. E., Gabriel, A. S., & DePuccio, M. J. (2018). Compassion practices, nurse’s well-being, and ambulatory patient experience ratings. Medical Care, 56, 4–10.  https://doi.org/10.1097/MLR.0000000000000834 CrossRefGoogle Scholar
  46. Neff, K. D. (2011). Self-compassion, self-esteem, and well-being. Social and Personality Psychology Compass, 5, 1–12.  https://doi.org/10.1111/j.1751-9004.2010.00330.x CrossRefGoogle Scholar
  47. Pastrana, S., Frewing, T., Grow, L., Nosik, M., Turner, M., & Carr, J. (2016). Frequently assigned readings in behavior analysis graduate training programs. Behavior Analysis in Practice, 3, 1–7.  https://doi.org/10.1007/s40617-016-0137-9 Google Scholar
  48. Post, S. G., Pomeroy, J., Keirns, C. C., Cover, V. I., Dorn, M. L., Boroson, L., et al. (2013). Brief report: Stony Brook guidelines on the ethics of the care of people with autism and their families. Journal of Autism and Developmental Disorders, 43(6), 1473–1476.  https://doi.org/10.1007/s10803-012-1680-z CrossRefGoogle Scholar
  49. Riess, H. (2015). The impact of clinical empathy on patients and clinicians: understanding empathy’s side effects. AJOB Neuroscience, 6(3), 51–53.  https://doi.org/10.1080/21507740.2015.1052591 CrossRefGoogle Scholar
  50. Riess, H. (2017). The science of empathy. Journal of Patient Experience, 4(2), 74–77.  https://doi.org/10.1177/2374373517699267 CrossRefGoogle Scholar
  51. Riess, H., Kelley, J. M., Baily, R. W., Dunn, E. J., & Phillips, M. (2012). Empathy training for resident physicians: a randomized controlled trial of neuroscience-informed curriculum. Journal of General Internal Medicine, 27(10), 1280–1286.  https://doi.org/10.1007/sll606-012-2063-z CrossRefGoogle Scholar
  52. Riess, H., & Kraft-Todd, G. (2014). E.M.P.A.T.H.Y.: a tool to enhance nonverbal communication between clinicians and their patients. Academic Medicine, 89, 1108–1112.CrossRefGoogle Scholar
  53. Sauro, J. (2011). How to interpret survey responses: 5 techniques. Retrieved from https://measuringu.com/interpret-responses/
  54. Schneider, J., Kaplan, S. H., Greenfield, S., Li, W., & Wilson, I. B. (2004). Better physician-patient relationships are associated with higher reported adherence to antiretroviral therapy in patients with HIV infection. Journal of General Internal Medicine, 19, 1096–1103.  https://doi.org/10.1111/j.1525-1497.2004.30418.x CrossRefGoogle Scholar
  55. Schwartz Center for Compassionate Healthcare. (2014). Understanding what patients want. Retrieved from http://www.theschwartzcenter.org/partnering-with-patients/understanding-what-patients-want/
  56. Segal, E. A., Gerdes, K. E., Lietz, C. A., Wagaman, M. A., & Geiger, J. M. (2017). Assessing empathy. New York, NY: Columbia University Press.Google Scholar
  57. Segal, J., & Smith, M. (2018). Conflict resolution skills. Retrieved from https://www.helpguide.org/articles/relationships-communication/conflict-resolution-skills.htm
  58. Sinclair, S., Beamer, K., Hack, T. F., McClement, S., Bouchal, S. R., Chochinov, H., & Hagen, N. A. (2016). Sympathy, empathy, and compassion: a grounded theory study of palliative care patients’ understandings, experiences, and preferences. Palliative Medicine, 31(5), 437–447.  https://doi.org/10.1177/0269216316663499 CrossRefGoogle Scholar
  59. Sinclair, S., Norris, J. M., McConnell, S. J., Chochinov, H. M., Hack, T. F., Hagen, N. A., et al. (2016). Compassion: a scoping review of the healthcare literature. BMC Palliative Care, 15(6), 6.  https://doi.org/10.1186/s12904-016-0080-0 CrossRefGoogle Scholar
  60. Strauss, C., Taylor, B. L., Gu, J., Kuyken, W., Baer, R., Jones, F., & Cavanagh, K. (2016). What is compassion and how can we measure it? A review of definitions and measures. Clinical Psychology Review, 47, 15–27.  https://doi.org/10.1016/j.cpr.2016.05.004 CrossRefGoogle Scholar
  61. The Skills You Need. (n.d.). 10 principles of listening. Retrieved from https://www.skillsyouneed.com/ips/listening-principles.html
  62. Tirsh, D., Schoendorff, B., & Silberstein, L. R. (2014). The ACT practitioner’s guide to the science of compassion: Tools for fostering psychological flexibility. Oakland, CA: New Harbinger.Google Scholar
  63. Tulgan, B. (2015). Bridging the soft skills gap: How to teach the missing basics to today’s young talent. Hoboken, NJ: Wiley.CrossRefGoogle Scholar
  64. Vazquez, M., Fryling, M. J., & Hernández, A. (2018). Assessment of parental acceptability and preference for behavioral interventions for feeding problems. Behavior Modification, 42, 1–15.  https://doi.org/10.11770/0145445517751435 Google Scholar
  65. Vilardaga, R. (2009). A relational frame theory account of empathy. International Journal of Behavioral Consultation and Therapy, 5, 178–184.  https://doi.org/10.1037/h0100879 CrossRefGoogle Scholar
  66. Weiss, R., Vittinghoff, E., Fang, M. C., Cimino, J. E. W., Chasteen, K. A., Arnold, R. M., et al. (2017). Associations of physician empathy with patient anxiety and ratings of communication in hospital admission encounters. Journal of Hospital Medicine, 10, 805–810.  https://doi.org/10.12788/jhm.2828 CrossRefGoogle Scholar
  67. Windover, A. K., Boissy, A., Rice, T., Gilligan, T., Velez, V., & Merlino, J. (2014). The REDE model of healthcare communication: Optimizing relationship as a therapeutic agent. Journal of Patient Experience, 1(1), 8–13.  https://doi.org/10.1177/237437431400100103 CrossRefGoogle Scholar
  68. Winkle, L. J. V., Schwartz, B. D., & Michels, N. (2017, December 11). A model to promote public health by adding evidence-based, empathy-enhancing programs to all undergraduate health-care curricula. Frontiers of Public Health., 5.  https://doi.org/10.3389/fpubh.2017.00339
  69. Wolf, M. M. (1978). Social validity: The case for subjective measurement or how applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis, 11, 203–214.  https://doi.org/10.1901/jaba.1978.11-203 CrossRefGoogle Scholar
  70. Worline, M. C., & Dutton, J. E. (2017). Awakening compassion at work: the quiet power that elevates people and organizations. Oakland, CA: Berrett-Koehler.Google Scholar

Copyright information

© Association for Behavior Analysis International 2018

Authors and Affiliations

  1. 1.Alpine Learning GroupParamusUSA
  2. 2.LeBlanc Behavioral ConsultingGoldenUSA
  3. 3.Behavior Analyst Certification BoardLittletonUSA

Personalised recommendations