# Enhancing Therapeutic Relationships in ABA Practice
Applied Behavior Analysis (ABA) has a strong foundation in data-driven intervention. Traditionally, it has focused on observable behavior and measurable outcomes, especially among individuals with autism. But as the field evolves, there’s increasing recognition that the quality of relationships—particularly the "therapeutic alliance"—plays a vital role in client progress.
A new article by Plattner and Anderson (2023), titled “Therapeutic Relationships in Applied Behavior Analysis: Current Status and Future Directions,” published in Behavior Analysis in Practice, explores this growing area. You can find the original study here: https://doi.org/10.1007/s40617-023-00819-8.
Let’s break down what this means for ABA practitioners and training programs today.
## What Is a Therapeutic Alliance?
The therapeutic alliance is a well-known concept in mental health fields like counseling and social work. It has three key parts:
- Agreement on treatment goals
- Agreement on treatment methods
- A caring and respectful bond between provider and client
When these elements are strong, clients are more likely to:
- Stick with treatment
- See better results
- Build trust with their provider
- Report higher satisfaction
## Where ABA Stands Now
Historically, ABA hasn’t emphasized relationship-building as in-depth as other professions have. Concepts like "behavioral artistry" (Foxx, 1998) and "compassionate care" (Taylor et al., 2018) have nudged the field in the right direction, but change has been slow.
The research shows:
- Many BCBAs score lower in interpersonal skills than mental health peers
- Families often report feeling unheard or misunderstood
- New BCBAs feel underprepared to manage parental stress or buy-in
These gaps highlight an urgent need to bring therapeutic alliance training into the ABA world.
## What BCBAs Say: Key Survey Results
Plattner and Anderson (2023) surveyed 277 certified behavior analysts (BCBAs). They came from various experience levels—from less than 2 years to over 6. The survey asked which parent conversations felt hardest to have. The top difficulties were:
1. Planning for difficult conversations
2. Discussing barriers to effective treatment
3. Addressing parent follow-through
4. Handling cancellations
5. Talking about caregiver stress
Interestingly, more experienced BCBAs were more comfortable with these issues. However, early-career practitioners struggled, often avoiding crucial discussions.
## Training Gaps in ABA
So where’s the disconnect? The survey revealed that many ABA programs don’t introduce key skills such as:
- Active listening
- Empathy development
- Collaborative goal setting
- Handling resistance with care and respect
Seven critical content areas are often missing from training:
1. Planning for difficult conversations
2. Addressing caregiver pushback
3. Practicing open-ended questioning
4. Rehearsing how to validate family goals
5. Inviting caregiver ideas and preferences
6. Gaining long-term buy-in
7. Communicating challenges honestly without blame
These are not just "soft skills"—they’re essential to successful practice.
## A Promising Solution: Motivational Interviewing (MI)
One approach that could fill this gap is Motivational Interviewing (MI). MI is a communication method from the field of counseling designed to strengthen a person’s motivation and commitment to change. Its key principles are:
- Partnering with families, not talking at them
- Showing empathy at every turn
- Honoring autonomy and avoiding judgment
Research shows MI improves outcomes in areas like:
- Smoking cessation
- Weight loss
- Medication compliance
- Addiction recovery
ABA professionals can also benefit by using MI’s core tools, known as the OARS model:
- Open-ended questions
- Affirmations
- Reflective listening
- Summarizing statements
MI blends easily with behavioral science and can be taught using behavioral skills training methods ABA practitioners already use daily.
## What the Survey Found About MI
MI is not yet widely known in ABA. In the same survey:
- Only 22.8% of BCBAs had heard of MI
- Of those, only 11 could accurately define it
- Nearly all who knew about MI learned it after grad school
Even so, a strong 74% of respondents wanted more support in building parent buy-in. There is a high demand for better training in this area.
## 10 Ways to Add MI to ABA Training
Training programs and supervisors can help the next wave of analysts develop stronger therapeutic skills by:
1. Offering a dedicated course on MI
2. Embedding MI in required coursework
3. Practicing OARS in class with roleplay and feedback
4. Inviting MI-trained professionals to guest lecture
5. Requiring supervised MI use during practicums
6. Adding interpersonal skills to student evaluations
7. Running MI-specific CEUs for current professionals
8. Creating challenging parent-case simulations
9. Encouraging reflection on therapist–client dynamics
10. Aligning MI practices with ethical decision making
## Pushback and Limitations
Some may argue MI is "outside the scope" of ABA, but that’s a misunderstanding. MI actions—like shaping motivation and reinforcing engagement—fit within behavior analysis when framed behaviorally. Some parts of the study relied on self-report data, so more observational studies are needed.
## Practical Applications
Here’s how to apply this knowledge:
- New BCBAs: Ask for mentorship in communication and empathy
- Experienced clinicians: Take MI-based CEUs and reflect on current practices
- Supervisors: Use MI principles in your mentorship model
Clients benefit most when we foster trust, collaboration, and compassion.
## Conclusion
ABA can no longer ignore the human side of service. Building strong therapeutic relationships leads to better outcomes, more cooperative families, and more effective treatment. Motivational Interviewing offers a well-tested, practical way to improve how we connect with others.
Now’s the time to update training programs, reflect on daily practice, and prioritize empathy as much as data.
## Call to Action
If you’re a behavior analyst, educator, or supervisor:
- Review your current training methods
- Explore MI training tools
- Consider how you support meaningful practitioner–family relationships
To dive deeper, start with the source: Plattner, C., & Anderson, C. (2023). “Therapeutic Relationships in Applied Behavior Analysis: Current Status and Future Directions.” Behavior Analysis in Practice, 16:1222–1230. https://doi.org/10.1007/s40617-023-00819-8
## Further Reading
1. Miller & Rollnick – Motivational Interviewing (Textbooks)
2. Motivational Interviewing Network of Trainers (MINT): www.motivationalinterviewing.org
3. LeBlanc et al. (2019) – Compassionate Care in ABA
4. Foxx (1998) – Behavioral Artistry
5. Taylor et al. (2018) – Parental Perceptions of Empathy
6. Callahan et al. (2019) – Comparing Practitioner Interpersonal Skills
7. Christopher & Dougher (2009) – Behavior Analytic Take on MI
8. Coursera & PESI – Online MI training platforms
9. Behavior Analyst Certification Board Ethics Code – Client collaboration sections
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