A quandary is a state of perplexity or uncertainty over what to do in a difficult situation. Every individual in any sort of occupational position is going to stumble upon a quandary from time to time. It is inevitable. And each occupation is going to have its own unique difficulties and dilemmas. Applied behavior analysts definitely have their own set of problems they have to overcome, things they need to watch out for and be vigilant of, and uncertain occurrences that happen that may need to be looked into.
Applied behavior analysts are trained to navigate most problematic events and/or ethical issues that pop up while working; however, there may come a time when that individual is surprised by a situation and they do not know what to do.
As an applied behavior analyst, ethical concerns are common. Few professions involve the level of intimacy and in-home care that ABA does, so therapists must be aware of the potential pitfalls of their profession. From overbearing parents to overbooked schedules, therapists must bring compassion and commitment to their work to overcome ethical issues.
This article will take readers through the top seven ethical quandaries that ABA therapists have the potential to face in their careers.
The seven ethical issues applied behavioral analysts must consider are:
- Self-Care Concerns
- Friendships with Clients or Families
- Inappropriate Parenting
- Financial Concerns
- Ethical Concerns with Employer
- Ethical Considerations Regarding Research
- Complicated Decision-Making
Becoming an ABA therapist requires a high level of compassion for others. Therapists may be yelled at or even physically assaulted while caring for children with developmental disabilities. More commonly, therapists may feel emotionally overwhelmed and drained by their jobs. Behavioral therapists have a special obligation to uphold their scheduling commitments, for example. Children with autism benefit from consistent schedules, so frequently calling in for mental health days is harmful to clients.
Professionals who work with clients need to be vigilant about how their own mental and physical health are affecting them in their work environment. Feeling overly exhausted, under the weather, and overworked can potentially lead to making inappropriate decisions.
The best thing for ABA therapists to do is to figure out what self-care techniques work for them and have a go-to “toolbox” of coping strategies they can rely on.
Psych Central lists nine self-care strategies that clinicians and therapists can use in their day-to-day life:
- Identify what activities help you feel your best.
- Put it on your calendar — in ink!
- Sneak in self-care where you can.
- Take care of yourself physically.
- Know when to say no.
- Check in with yourself regularly.
- Surround yourself with great people.
- Consider the quality of self-care.
- Remember that self-care is non-negotiable.
Friendships with Clients or Families
With long hours spent working with a single client, often in a family’s home, it’s easy for ABA therapists to build relationships. However, as professionals, ABA providers must maintain appropriate boundaries. This might mean turning down an invitation to stay for dinner, declining to meet the family outside of the home or redirecting intimate conversations. Training programs in ABA techniques can help students learn how to gracefully set boundaries with clients and families.
Below are a few ethical scenarios that are good examples of what ABA therapists hope not to encounter.
- The therapist spends lengthy phone hours with the client during the work day or even on personal time.
- The therapist may begin to spend frequent time with clients at various restaurants, movie theaters, or other public places outside of the client’s home, or even at the therapist’s home, under the guise of a client visit.
- The therapist tends to spend an inordinate amount of time with the client, both scheduled and unscheduled visits, in comparison to other clients.
The best route to go is to use common sense in these types of situations.
Having a child with autism can be stressful. Between emotional meltdowns, social skills and communication training, perhaps even toilet training, and the need for constant supervision, parents can quickly reach the breaking point. ABA therapists may witness inappropriate behavior, such as a parent yelling at a child, locking a child in a room for time-out, or even using pseudoscientific “cures” for autism, like essential oils or bleach. In these situations, ABA therapists must balance the obligation to protect their clients with the need to allow families to manage their own lives. According to the Centers for Disease Control and Treatment, up to one-third of parents of children with autism try alternative medical therapies, some of which may be harmful, so ABA providers must be prepared to encounter this issue.
- Children need you to separate behavior from love.
- Kids need consistency.
- You must take care of yourself to take care of others.
- You can ask for help.
- When you enable, you disable.
- Practice what you preach.
- Give the plan time to work.
Unless the parent is harming their child or self, or is an imminent danger to the child, any intervention needs to be dealt with lightly. It is not appropriate to reprimand the parent or tell them how to parent their own child; however, suggestions and recommendations can be positively stated and given.
As service providers, ABA specialists may struggle with charging appropriate prices for their services. If a family claims they cannot afford their co-pay or begs for additional, non-compensated therapy, it may be hard for a compassionate provider to say no. ABA therapists must be willing to stand up for themselves, refuse to work for free, and follow up on unpaid bills. Some of this difficulty can be alleviated by working for an organization that handles billing, leaving the therapist free to concentrate on providing excellent services.
Establishing fees, handling the non-payment of fees, and the issues of bartering, and exchanging gifts are all ethical quandaries to consider. Having a bottom line for fees can be difficult. It’s all about meeting in the middle and being a little flexible. Therapists don’t need to be too harsh and lose clients that need help, yet they also don’t want to be used or exploited for being nice. ABA therapists should decide what their low limits are for a sliding scale (if they choose) and be prepared for clients to inquire about fees.
If you are new to ABA therapy and aren’t sure about the fees, ask around to other more seasoned therapists and see how they have their business set up.
Ethical Concerns with Employer
Although most people who start an ABA therapy business have their hearts in the right place, it’s easy to get sidelined by regulations, overhead costs, and a competitive market. Small companies might find themselves cutting corners, and large corporations may be more concerned with turning a profit than helping clients. Entry-level ABA professionals may not have the confidence to stand up to a boss or raise ethical concerns in the workplace.
As the ABA field grows and distinguishes itself from other psychology specialties, therapists will develop their own ethical code. For now, applied behavioral analysts facing ethical dilemmas can rely on professors, coworkers, mentors, and employers for help.
APA Services list various ethical issues related to supervision, as in these are potential issues that any type of therapist might encounter with their supervisor or employer.
- Boundaries of Competence
- Delegation of Work to Others
- Exploitative Relationships
- Accuracy in Reports to Payers and Funding Sources
- Design of Education and Training Programs
- Student Disclosure of Personal Information
- Assessing Student and Supervisee Performance
- Sexual Relationships With Students and Supervisees
- Publication Credit
- Assessment by Unqualified Persons
- Informed Consent to Therapy
Ethical Considerations Regarding Research
When therapists, educators, or really whomever are conducting research in order to search for and to implement a new educational or behavioral strategy, things can easily go wrong. Not every single study online is valid or peer-reviewed, and each one should not be followed blindly. Many studies are difficult to read and do not take the average person into account regarding readability; this can cause issues when someone on the outside is interpreting the data and results.
Other limitations and considerations to take into account are:
- Not all studies have been approved by an Institutional Review board.
- Not all studies are reliable or valid.
- Not all studies have used an appropriate sampling pool of participants.
- Not all studies have reduced the risk of harm to all involved.
- Not all studies have a lack of conflict of interest.
- Not all studies are transparent with their findings.
- Not all studies come forward with the limitations.
When using treatment methods to use with clients, ABA therapists need to ensure they are using research-based, sound, and up-to-date studies to back up their reasoning for using those techniques. Increasing research literacy is always encouraged!
ABA therapists will need to make complicated decisions throughout their career; it is inevitable. Unfortunately, it is hard to determine when a crucial decision must be made regarding a client, treatment method, or occurrence, as the need for action can happen so spontaneously; therefore, understanding how to make ethically-based decisions is a highly important skill ABA therapists should practice, because ethical dilemmas come in all shapes and sizes and can happen at any moment.
An article from the professionals at the Science Education Resource Center at Carleton College discuss the concept of beneficence and questions professionals should ask themselves when caught in an ethical quandary.
Beneficence is the concept that scientific research should have as a goal the welfare of society. It is rooted in medical research, the central tenet is “do no harm” (and corollaries remove harm, prevent harm, optimize benefits, “do good”). For a more expansive introduction to beneficence, see the essay on The Principles of Beneficence in Applied Ethics from the Stanford Encyclopedia of Philosophy. Some simple guiding questions in applying the concept of beneficence to ethical dilemmas include:
- Who benefits?
- Who are the stakeholders?
- Who are the decision-makers?
- Who is impacted?
- What are the risks?
By asking themselves these questions along with taking a deep dive into the situation with perhaps a colleague, supervisor, or mentor, the ABA therapist will minimize any harmful outcome the decision may have upon the client.
How to Speak Up About Ethical Issues
If you are an ABA therapist, support one, or are working with one as the client’s (child or adult with autism) teacher or parent, and you have encountered an ethical issue during a session, it is important that you are aware of the appropriate route to take to make the issue known and get it resolved.
Each place of business should have some form of ethical compliance training through their human resource department; and those ABA therapists who work for themselves, are freelancing, or are contracted out hopefully had some form of training on this topic during their educational/professional experience.
Regarding ethical issues in the workplace, a Gallup article states:
Cultures that prompt employees to reflect on and question workplace scenarios without fear give employees a platform for their concerns about serious ethical problems.
As well as…
Managers need to make integrity, ethics, and compliance a regular topic of conversation to familiarize employees with these topics and give them practice discussing their implications.
While not all individuals feel comfortable reporting an ethical issue, the hope is that through education, support, and an understanding that it is the right thing to do, more and more will report if necessary.
In the meantime, ABA therapists need to take responsibility for their actions, work with ethics in mind at all times, and always do what is best for their client’s physical and mental health and well-being.
Updated March 2021