# 🧠Dignity and Respect in Behavior Analysis: Why Therapeutic Assent Matters
Behavior analysis is rooted in helping individuals live more independent, meaningful lives. But in order to truly honor our clients, especially those who are neurodiverse or have limited communication, we must move beyond a narrow behavioral framework. A recent paper by Jaime Flowers and Jillian Dawes (2023), titled [“Dignity and Respect: Why Therapeutic Assent Matters”](https://doi.org/10.1007/s40617-023-00772-6), urges behavior analysts to prioritize therapeutic assent — a process that supports client dignity, autonomy, and collaboration.
In this blog post, we’ll review the key points from the article, outline practical strategies for implementation, and discuss why assent is not just ethical, but essential for quality care.
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## 🔍 What Is Therapeutic Assent?
Therapeutic assent happens when a client — even without legal rights to give full consent — agrees to take part in services. It shows that:
- The client understands, to the best of their ability, what’s being asked of them.
- The client is willing to participate.
- The client’s preferences and comfort are considered.
This is distinct from informed consent, which is given by someone legally authorized (like a parent or guardian). Assent is about respect, trust, and ongoing cooperation within a therapy relationship.
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## 🤝 Why Assent Matters in ABA
Therapeutic assent is especially relevant to applied behavior analysis (ABA) due to several factors:
1. ABA frequently serves minors and adults under guardianship.
2. Clients may use limited or nonverbal communication.
3. Refusing tasks (so-called “noncompliance”) may signal distress or objection.
Flowers and Dawes (2023) argue that assent is a moral commitment, not just a legal consideration. Without it, we risk using behavior change tools in ways that are confusing, coercive, or even harmful.
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## ⚖️ Ethical Standards Across Professions
Many codes of ethics already emphasize the importance of assent. The Behavior Analyst Certification Board (BACB), the American Psychological Association (APA), and the National Association of School Psychologists (NASP) all support principles like:
- Seeking assent when appropriate.
- Respecting nonverbal cues of dissent.
- Avoiding overwhelming information during explanations.
- Involving stakeholders and caregivers to support decision-making.
- Documenting assent and checking in regularly.
These guidelines promote respect — and help foster partnerships instead of power struggles.
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## 🧩 Challenges Specific to ABA
Despite these ethical standards, ABA faces unique hurdles in using assent effectively:
- Clients may not speak or use formal language.
- Certain behaviors (like escape or refusal) are treated as targets for reduction — even when they could signal withdrawal of assent.
- Too often, assent is treated as a “one and done” checkbox rather than an ongoing process.
Without careful attention, ABA risks ignoring client signals or overriding their comfort. That erodes trust—and may reduce the long-term success of therapy.
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## đź› 10 Ways to Encourage Assent in Practice
Here are actionable strategies you can begin using:
1. Write simple explanations about tasks and schedules.
2. Use visual supports like choice boards or storybooks.
3. Include daily check-ins with verbal or gestural prompts for “yes” or “no.”
4. Create systems for clients to say “I want a break” or “not now.”
5. Let clients choose activities, reinforcers, or order of tasks.
6. Look for body language or facial cues that suggest frustration or discomfort.
7. Treat expressions of dissent as feedback—not misbehavior.
8. Review client preferences weekly, not just at intake.
9. Integrate caregiver insights, especially with nonvocal clients.
10. Adjust treatment based on what the client seems to want or need.
Assent isn’t about letting clients run the session. It’s about inviting them to take part in a way that feels safe and respectful.
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## đź“Š Social Validity and Assent Go Hand in Hand
In ABA, social validity means we're targeting goals and using methods that people actually value. In 1978, Wolf described three pillars:
1. Meaningful goals
2. Acceptable strategies
3. Beneficial outcomes
If clients don’t feel heard — or we ignore their verbal or nonverbal input — none of those pillars hold. Assent helps us ensure the client is on board, every step of the way.
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## 🧪 Assent in Research vs. Therapy
There are key differences:
| Research | Therapy |
|---------|--------|
| Assent is often one-time | Assent should be ongoing |
| Null results are expected | We must adjust when treatment isn’t working |
| Participation has fixed scope | Treatment changes over time |
Therapists must check in with their clients regularly and look for signs that a plan is no longer acceptable or effective.
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## 👶 Case Example: Teaching a "Red Card" Dissent Cue
Imagine a 6-year-old autistic child with limited words. By teaching her to show a green card for “okay” and a red card for “no thanks,” her therapist creates a simple but powerful way to monitor assent.
When she holds up the red card during a task, the therapist pauses, re-assesses, and modifies the demand. Over time, the child engages more in therapy, shows fewer escape behaviors, and builds trust with her team.
This example shows how small steps can lead to big changes when dignity and voice are prioritized.
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## đź“Ś Final Thoughts
Flowers and Dawes (2023) make a compelling case: gaining and keeping therapeutic assent should be standard practice in ABA. It supports five important values:
1. Client dignity
2. Autonomy
3. Trust in therapy
4. Better outcomes
5. Ethical integrity
ABA professionals must be proactive—not reactive—when it comes to assent. With appropriate supports and strategies, all clients can have a say in their treatment, regardless of age or communication abilities.
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## đź“š For Further Reading
- Flowers, J., & Dawes, J. (2023). “Dignity and Respect: Why Therapeutic Assent Matters.” Behavior Analysis in Practice, 16:913–920. [https://doi.org/10.1007/s40617-023-00772-6](https://doi.org/10.1007/s40617-023-00772-6)
- Behavior Analyst Certification Board’s Ethics Code: [https://www.bacb.com/ethics-code](https://www.bacb.com/ethics-code)
- Wolf, M.M. (1978). Social Validity: The Case for Subjective Measurement, JABA.
🔔 Do you talk with your clients about their comfort and choice in therapy? It’s time to start. Let’s lead with dignity, respect, and collaboration — not just compliance.
