ABA vs. MA/PsyD Psychotherapy insights?

[raincoffeecats]

Hello!  This is my first post here and I'm looking for some feedback, advice, and your experience in the fields of behavior analysis and psychotherapy. 

I have a career dilemma.  Long time ago I got a BS in Animal Bio, then became interested in Psych and behavior.  Now I have been working as an RBT (registered behavior technician) for 4 years with children on autism spectrum, and provide in-home services related to problem behaviors, and debating whether I should get a masters in applied behavior analysis (ABA) or get a masters/PsyD and practice as a therapist.  ABA is a fast growing and changing field right now, and supposed to pay better than an MFT/MSW for example.  I am extremely conflict avoidant, and don't enjoy crisis situations, although I have become more or less accustomed to them, working with kids with autism and at a group home with troubled youth.  While I understand all jobs have ups and downs, to be blunt, I want an "easy" job.  I like the job of the LPC I see at the daycare who walks around and establishes rapport with kids, and counsels them on as needed basis.  She does not do crisis intervention, or discipline them in anyway.  I also LOVE the idea of working as a therapist and doing play therapy with kids, who come to my office, so I don't have to make house calls (and deal with the sometimes unstable home environment).  The downside of that is that I won't know if the job of a therapist is really for me until I have the actual degree.  The therapists that I've interviewed or have seen sometimes seem really burnt out.  I don't want an MFT because the couples fighting can get pretty intense.  I want to get an MA in Mental Health, but worried about state-to-state licensure, since I do not know where I will live yet (I currently live in Hawaii, but my husband is applying to jobs out of state, so we're not planning to stay here forever).  

I have a love-hate relationship with the ABA field (applied behavior analysis) because it is akin to animal training, and while effective, I feel it lacks emphasis on empathy and making a connection with the child (sort of what Dr. Laura Markham's blog ahaparenting.com talks about), but I feel it would be unethical for me to suggest this to clients, because it's not really ABA.  To me ABA seems that it's lacking depth and is too robotic with it's reinforcement principles and constricted with its application in autism (supposedly it has other applications, but it's really rare to find a job outside of the autism diagnosis).  I also don't like the possibility of injury - kids have hit, bit, spat, and swore at me, they may be teenagers and bigger than me - I am a 5'2 female with history of domestic violence, so this scares me.  I can't tell you how many times I've come home crying because of these aggressive behaviors I've had to deal with, and I'd blame myself, there's little support within the profession, and it's just a very difficult job. I've had a PsyD therapist tell me my job is so much harder than hers.  

What I love about ABA is the one-on-one relationship I get to build with my client.  I also love working with kids, especially younger ones, making that connection with them, being their coach, seeing them grow and overcome challenges with my help is SO rewarding.  I'm also good at this job, I feel like I have a knack for it (I've had supervisors tell me this), and it is an in-demand field.  

SO I've been sitting on this dilemma for a year or two now, and feel a lot of pressure to make a decision already, I am 29 years old, and desperately wanting to to be financially independent and get on with my life with a permanent job, that I only see for myself after grad school.

I know this was long, sorry about that.  Really appreciate any help you may have, and feel free to ask questions. 

Edited February 11, 2018 by Lucy K
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[Lindsc237]

Hi raincoffeecats. It sounds like you have a really big decision ahead of you to make. Hopefully some of what I have to say can help.

Like you, I've been working for about 4-5 years as an behavior therapist. (Like an RBT, but not officially. The states I've worked in haven't required the credential because they hire off experience, but I am currently in the process of applying for it so I can work in different states. But literally no different in terms of responsibilities.) I have to be totally honest with you: I love it. When I began to think about grad school around this time last year, there was no doubt in my mind that I wanted to get my masters in ABA.

For me, it really is one of the most interesting jobs in the world. I've worked other jobs, and being a behavior therapist means walking into a totally new situation every time, even with the same clients. I get to help make positive change in their lives. And having the behavior analysis background, it requires a good deal of careful observation and problem solving to address problem behavior and turn it into something positive. Frankly, I love the challenge that this field poses.

With that said, if you aren't 100% sure you want to pursue ABA as a career, I don't recommend that you do it. It is a very challenging field to be in and requires a great deal of personal motivation and interest to sustain. Still, I wouldn't count yourself out just yet. From what you wrote, it sounds like you have some misconceptions about ABA (It's okay, everyone does.). ABA is a science, yes. It is a science just as much as medicine or psychotherapy or nursing. Yes, the application from animals to humans is discomforting. But think about classic psychology experiments on mice and monkeys (e.g. Harlow's study on "contact comfort" in infants using infant monkeys). It's not just ABA that is rooted in animal research; most scientific fields with clinical applications are. That's just the history of it. Secondly, I personally disagree with you in regards to ABA lacking empathy or connection. I think being able to teach someone how to take care of themselves or how to make friends or how to get to work using the bus is one of the most empathetic things I can do as a human being. And, even though I'm speaking from the therapist's perspective, I think it goes both ways. As an example, I used to work at a group home for adults with severe autism and intellectual disability a few years back. I had one client who, when I walked in at work, would take my hand and look to see what color I painted my nails. It seemed trivial to me, but it made them smile from cheek to cheek. And because I was in school, I would sometimes come back to that job after being away for months, and without fail, this client would look at my nails the moment they saw me. The thing with autism, is that people who have it see and experience the world differently. But, with that said, they still want to do all the things we want to do. They want to have friends, to follow their passions in life and do what is meaningful to them, fall in love, and have a generally happy life. While autism can actually bring some creativity to the table in terms of how this is accomplished, it can also hinder accomplishing these goals. And that's why I think ABA is important and valid. Personally, I think that if someone doesn't know how to brush their teeth because they have autism, we should not be saying that "forcing them" to learn how to do that (in a way where they can understand) is wrong. On the contrary, I think it would be extremely inhumane to forego teaching them to brush their teeth and allow them to get gum disease because we don't want to "force" them to learn how to take care of themselves.

How a therapist chooses to teach them though, varies from person to person. Being respectful (and knowing what "respectful" looks like for someone with autism) is not something that can always be taught and understood at first glance. It is something that takes a significant amount of time and dedication to learn, and frankly, mistakes. I have found myself (and also, from other professionals I know) that involving yourself or at least being aware of autism advocacy is a great way to do this. There are many resources out there, but a couple of places I would look are the Autistic Self-Advocacy Network (ASAN) and Operational Meaningful Life. There are many others, which I'm sure you will find in your travels.

Which brings me back to your situation. I don't know if you've delved at all into advocacy, but I think you should give it a chance. What motivates me and a lot of professionals to join the field is not always the pay. For most, it's being aware of the injustices that are carried out against people with autism and other disabilities, and being able to do something about it. Half of my job as a behavior therapist is to educate parents about ways they can help their kids, resources that are available to them, and helping them to understand how their children see the world. Crazy that, at 22, I'm given this huge responsibility. But it's something I spend a lot of time on, because I personally need to know that what I'm doing is helping. That's empathy and compassion; ABA is just a tool to help me put that empathy and compassion to good use.

Look. I can't tell you for sure whether being a behavior therapist or a counseling therapist is right for you. But being someone who, at this point in her life, is so certain of this career choice, maybe you can start to ask yourself the right kinds of questions to get to where you want to be. And I sure as hell don't know a thing about counseling psychology; that's for someone else to answer to. Regardless of what you choose, both of those fields would allow you the chance to change someone's life for the better, and it's something you should be proud of.  I wish you the best of luck moving forward with your decision.

Edited February 14, 2018 by Lindsc237

[birdy-bear]

@Lindsc237 already hit all the major points out of the park, so I second everything they said and only have a few points to add. As mentioned above, ABA is a science, and your ABA agency has trained you in one application. It sounds like you might be more interested in more naturalistic ABA applications--check out Early Start Denver Model, Pivotal Response Training (similar to: Natural Environment Teaching, Enhanced Milieu Teaching), and Positive Behavior Supports. I think you'll find these applications to be more naturalistic and person-centered and less robotic than the application you describe. 

I'd also recommend shadowing BCBAs in other settings if you can. I work as a BCBA in an ABA preschool, and most of your concerns don't apply in my setting. We are (almost) entirely clinic-based, so I very rarely go into family homes. The majority of my clients are 3-6, so crisis behaviors are typically not as dangerous to the client or myself as they are with older clients. I collaborate with an SLP and another BCBA, and get to be in constant contact with our technicians (since we're all on-site), so I think everyone feels a lot more supported and connected than in-home technicians and clinicians tend to. And finally, the majority of instruction in our preschool is embedded naturalistically into typical preschool routines (science, art, circle time), so it doesn't have the "robot instruction vibes" that get conflated with ABA.

As far as looking into programs, I'd recommend finding professors doing research on those naturalistic ABA applications listed above, and working your way back to programs from there. If you do end up staying in Hawaii, check out Dr. Jennifer Ninci! She does research with little ones and her work might be up your alley. If you are looking into programs on the mainland, a school psych/ABA or social work/ABA program sounds like it could be your speed. Alternatively, I did a SPED/ABA program and was really pleased with the person-centered focus of my education. University of Oregon (Dr. Laura Lee McIntyre in School Psych) and Saint Louis University (MSW with an ABA focus) might be good programs to look into as you start your research!

[birdy-bear]

P.S. If you feel comfortable doing so, please talk to your supervising BCBA about your history of domestic abuse and getting reassigned to younger, smaller clients that don't make you feel scared on a regular basis! I've only had one bigger client with severe/dangerous challenging behavior at my current agency, but I checked in frequently with his technicians to make sure they felt comfortable and safe; they were well aware that they could remove themselves from his case at any time. No compassionate BCBA would require you to stay with clients that make you feel unsafe, especially considering you're working 1:1 in the home without backup and you're smaller than your clients!

Edited February 14, 2018 by birdy-bear

[zoelee]

Thank you for your post and the replies. I'm completely outside your fields but do have an interest in therapy/counseling. So your conversations are eye-opening and confusing at the same time, because there are assumptions you all seem to be clear about,  but not me. And I'd like to get some clarifications on those.

Coffee mentioned choosing between ABA and counseling, and you linked ABA with autism. So is it the case that ABA is a method that mainly deals with autism? V.S. counseling deals with everything else? Or you meant, ABA is making home calls (or working at preschool) while counseling is patient seeing the therapist in his office/facility? 

A more specific question for Coffee, how did you become a registered behavior technician without a MS/PhD in psychological counseling? I thought a Master degree in therapy is the required for any type of counseling/therapy job. I would like to know how,  because I would love to give it a try if it's available in my state. 

Thanks very much!

 

 

[HT20]

@zoelee  I can answer a couple of your questions. Yes, ABA/becoming a Board Certified Behavior Analyst (BCBA) deals mostly with autism. A MA or MS in mental health counseling would typically cover things like depression, anxiety, other internalizing disorders, adjustment issues, etc. Counseling therapists typically work in a clinic where clients come to them. Some BCBAs/RBTs work in clients' homes, in their schools, or in a clinic. You need a masters degree in Behavior Analysis or in a related field such as psych, special ed, education with an additional certified course sequence in ABA to become a BCBA. RBTs (Registered Behavior Technicians, sometimes referred to as "behavior therapists") can be hired with just a bachelors degree in psych or another related field. They work under masters level BCBAs directly implementing programming developed by the BCBAs with clients. It's a pretty unique job in that bachelors-level graduates can get clinical experience working with clients. A lot of clients on the spectrum also have comorbid anxiety, OCD, PDD, ODD, etc. so it can be good experience with being exposed to a variety of disorders. Like I mentioned earlier, sometimes people refer to RBTs as behavior 'therapists', but it's a bit of a misnomer in my opinion. RBTs are not therapists in the same sense that a masters level counselor would be. I refer to myself as a Registered Behavior 'Technician', which is what the Behavior Analyst Certification Board (BACB) calls them. Depending on where you live, there may be several agencies in your area hiring for RBTs. Behavior Analysis as a field and treatment for autism is becoming much more widespread and the demand for RBTs and BCBAs is increasing throughout the country. At this point in my life, I'm hoping to pursue becoming a clinical psychologist, but my ABA job has been very good clinical experience and has helped solidify my desire to work in the mental health industry. If you want to pursue becoming an RBT, I'd search "registered behavior technician" or "ABA therapist" in indeed.com with your zip code. I'd bet that there are some agencies in your area where you could apply if you're interested.  

[zoelee]

thanks HT20. Looks like your Animal Bio is considered a related area. Unfortunately I only got a fashion design, graphic design degree. I'm thinking of going back to school, but with my age (47), and family to support, it's a big and tough decision.

[raincoffeecats]

Wow thank you everyone for your replies!  It was my first post, so I thought I'd automatically get a notification in an e-mail.  Good thing I logged in to check!   @Lindsc237 and @birdy-bear thank you so much for the wonderful resources, I'll be sure to check them out. 

Thank you @HT20 for answering @zoelee's question for me. I would just add that the way I became an RBT (sometimes also referred to as a "skills trainer") is by applying for a "behavior technician" position.  Although I had a BS in an unrelated field, my prior 2+ years experience volunteering with children at a domestic violence shelter and later working at a group home qualified me.  Once I got hired, I did a 40 hour training and after completing a certain amount of hours working under my BCBA supervisor with our client, I passed a test to become a registered behavior tech (RBT).  Some companies are willing to train upon hire, so a few years odexperience working with children may be enough.

@birdy-bear thank you very much for the specializations you suggested, you are right, they sound right up my alley, and thank you for the school recommendation.  Perhaps I should have been more open with my supervisors about my history, but thankfully I mostly work with 4-8 year olds.  I did work with a 3-5 year old that had aggressive and self-injurious behaviors, so maybe that alone was a trigger for me.  I did feel really unsupported working with clients in-home, especially at the beginning.  I am considering online programs (although I am wary of online degrees such as the Florida Tech's BCBA program, which I heard great things about, do you have any input on good online programs for BCBA and/or MSW?

Also @birdy-bear may I pick your brain a little bit?  If you have time, could you tell me what a day in your life at work is like?  What is an ABA preschool?  What are some things you like and dislike about your job?  I think I am self-conscious working in this field because by nature I am shy and soft-spoken - a true introvert- though I learned to mask it, it is an effort.  I wish I had that bubbly, outgoing, energetic personality I often see in this profession.  Anyway THANK YOU!  I'll go change my settings now so it won't take me a week to reply!