The Lift 009 | Interpersonal and Therapeutic Relationship Skills

Dr. Linda LeBlanc (00:06):

Welcome to Episode 9 of The Lift. I'm Dr. Linda LeBlanc.

Dr. Tyra Sellers (00:12):

And I'm Dr. Tyra Sellers. 

Dr. Linda LeBlanc (00:13):

We are gonna be talking with you about interpersonal and therapeutic relationship skills. We are so excited to have our colleague and friend, Dr. Bridget Taylor, with us today. She is one of my favorite people. She's a collaborator and just a real spirit animal for me and my work, in the area of autism. She's the co-founder and CEO of Alpine Learning Group. She got her PsyD from Rutgers university and is a BCBA-D as well as a licensed psychologist. She is, most recently, the past president of the Behavior Analyst Certification board, she serves on the Autism Advisory group for the Cambridge Center for Behavioral Studies, she's been an associate editor for the Journal of Applied Behavioral Analysis, she serves on the editorial board of Behavioral Interventions and is a reviewer for many journals. She is an ABAI fellow, an amazing human being and really an authority on effective, innovative interventions and compassionate care for individuals with autism and their family. Yay, Bridget! Thank you for being here.

Dr. Tyra Sellers (01:25):

Yay!

Dr. Bridget Taylor (01:26):

Thank you so much, Linda and Tyra, for inviting me. I'm really excited about the topic today. I really appreciate the invitation.

Dr. Linda LeBlanc (01:35):

We couldn't think of anyone better than you to talk about these skill sets, which are really related to how we have an impact on people. The quote for this chapter is by Mya Angelou, another amazing human being: “I've learned that people will forget what you said. People will forget what you did, but people will never forget how you made them feel.” That statement about the importance of the impact that we have on other people really speaks to why interpersonal skills and therapeutic relationship skills are so important in behavior analysis.

Dr. Bridget Taylor (02:24):

Yes, I couldn't agree more and it's a really beautiful quote. It actually reminds me of a quote that's well known out there by Theodore Roosevelt, which is, “People don't care how much you know, until they know how much you care.” We are so good at training the technical skills of our clinicians and our university training programs are so good at helping us to be really good at our verbal skills, and being able to articulate the technology, but really when it comes down to it, it's how you communicate what it is that we're so good at doing, and that relationship that we form with the people, with our families, with the clients whom we're trusted with caring for. It is about that relationship as being really important and pivotal in the work that we do.

Dr. Tyra Sellers (03:17):

So well said.

Dr. Linda LeBlanc (03:18):

This is from our book, one of the statements that meant a lot to us as we wrote this chapter, and that is that care and compassion for the wellbeing of others, propels our practice. To me, that's critical that every behavior analyst know. It also is integral in our science. These two things don't have to be separate. They don't have to be dichotomous. You have to be one or the other. If you are an effective behavior analyst supervisor, if you're teaching other people these skills, you are gonna be most successful if you're in the game because of care and compassion for others.

Dr. Bridget Taylor (04:17):

Yeah. So much of what we do are relational acts, and when you are in a family's home, helping them learn how to interact with their child or teaching them skills that they need to be effective teachers of their children, they are relational acts. When we ask families to do things, we're in a relationship with them. It is a special relationship, but that requires that we practice those relationship skills and the empathy and the perspective and the compassion.

Dr. Linda LeBlanc (04:49):

We shouldn't be surprised if we're not very effective, if we're not paying attention to that. [Laughing] Those interpersonal skills set the ceiling on how effective we're gonna be able to be no matter what else we know, because if we behave in ways that distance people from us, or make them less willing to follow our lead, to listen, to trust what we say, that's on us and the success and the part of behaving in ways that lead them to trust our instinct, trust our intent, trust our caring. That's on us too, and we achieve that with our interpersonal skills.

Dr. Tyra Sellers (05:35):

Yes, and that makes me think about this idea that compassion is multifaceted, but primarily focusing on identifying that someone else is experiencing something, connecting with that experience, and wanting to do something to support, change, alleviate, what have you. At the same time, I think about how most of what we ask folks to do is more effortful than what they have been doing. At least in the short run, or in the short term. It might not feel great, or it might at least feel awkward. If you aren't coming from a place of compassion and being very clear about that, I don't know how we expect folks to engage in trusting relationships where they then will do those more effortful or more awkward things, if they are not aware that those recommendations are coming from that place of compassion in the service of improving their lives, the lives of other individuals. 

Dr. Bridget Taylor (06:48):

This has been demonstrated time and again, in other healthcare industries. Think about our own personal experiences with our medical professionals, whom we interact with over our healthcare. We are more likely to follow recommendations, and this has been documented through research in medicine. When our doctor interacts with us in a compassionate, empathic way, when they take the time to really understand what we are struggling with, help us to identify potentially some of the obstacles that we may confront in implementing our own treatment. We have to make that effort with our clients whom we serve. We have to make time to have those relationships. The number of hours that most of our learners are engaged in treatment is many, many hours that clinicians have to entrust us with the care of their child. As Tyra said, to follow our recommendations, there has to be a level of trust there. That comes with our behavior and how we're interacting with them.

Dr. Tyra Sellers (07:50):

Agreed.

Dr. Linda LeBlanc (07:51):

In this chapter of the book, we talk about five core interpersonal skills, and it's not like they're all completely separate and distinct. They all overlap and when they all come together, you are firing on all of these cylinders, people around you know. You impact others in positive ways, and the term’s been used, “behavioral artist”and the notion is that if you are paying attention to these core skills, you can really influence other people in meaningful and precise and really impactful ways. The five we talk about, and they're certainly not the only interpersonal skills, but it's communication skills, noticing and self-reflection, perspective taking, flexibility and compromise, and integrity and accountability. I don't know that we're gonna have time to go through all of those in detail, but I thought maybe we could each pick a favorite that we want to discuss with the others, and that'll allow us to hit two or three of these. Why we think this is one of the important ones, whether we happen to be particularly good at it or not [Laughing], or if we're on a journey to becoming better at it. Tyra, do you want to kick us off? Do you have a favorite of those five that you want to chat about?

Dr. Tyra Sellers (09:36):

Sure. It’s difficult to pick a favorite [Laughing], but I would say noticing, and self-reflection only because that's an area that is difficult for me and has been throughout my career. I think it's difficult for many of us because I don't think it's something that is taught well or modeled in an explicit way for us. The idea that it's important that I need to be an observer and a listener to my own behavior while I'm engaging in it, which is really hard. I tend to be more of a bull in a China shop kind of person. I just engage in a bunch of behavior and let it get shaped, which I think is a great way, generally, to explore the world. When you're talking about high stakes interactions where you could be hurting someone, you could be behaving with great intentions, but not having the right impact, it requires that restraint and that slow down, and that self-serving. I've struggled with it in lots of different applications, in my professional and personal life. I think that's probably my favorite, that you have to be willing to find a way to observe your behavior, to be a listener to your own verbal behavior, and then to really think about and reflect on what motivated that behavior. Why did you engage in that behavior? You're the only one that can discover that, right? You have access to variables that other people don't, and really making a choice to purposefully behave in a different way under similar conditions in the future. If you didn't get the result that you needed, you just can't leave it to chance. Particularly when you're talking about dealing with vulnerable folks. That's my fave.

Dr. Linda LeBlanc (11:43):

Yeah. It's a good one. Bridget, what do you think about that one? The noticing and self-reflection.

Dr. Bridget Taylor (11:49):

Oh, you know, she stole it from me. 

Dr. Linda LeBlanc (11:51):

[Laughing] “You stole my favorite!” 

Dr. Bridget Taylor (11:54):

I will build on that. The runner up is perspective taking, and I think the self-reflection is part perspective taking, part of that self-reflection. When I have an interaction with a parent, and I don't think that interaction went the way I really wanted it to go, because maybe I said something that was unintentionally hurtful. Something that I said that I walked away from and maybe felt badly, it happens. My self-reflection of the conversation, understanding what it's like for the family to have received that communication requires perspective taking. We know that perspective taking is the old saying, “Walking in someone else's shoes”, but the truth is I'll never be able to fully be in those shoes. I have to always draw on my own personal experience of distress and loss. For example, if I'm working with a family of a newly diagnosed child, to inform me about what that experience might be like for that parent. Self-reflection in the moment is so hard, right? Moment by moment. I'm the same way. It’s always after the fact that I go, “I think my tone, and I could've, and I…”

Dr. Linda LeBlanc (13:14):

Yep, and I will next time. Even better! [Laughing]

Dr. Bridget Taylor (13:16):

It’s a learning experience, and that's when that self-compassion comes in, which is to be easy on yourself and to say, “You know, we have tomorrow. I can tell my staff.” There are plenty of times where I've picked up a phone and called a parent back and said, “Hey, I want to revisit this conversation and apologize for something that I said”, or “Let me check in with you on how you assess the conversation”. That only comes with self-reflection, and perspective taking becomes part of that.

Dr. Tyra Sellers (13:44):

Yeah, I love that.

 

Dr. Linda LeBlanc (13:46):

I love that too and you took mine, and that's a really good one. I am becoming ever more convinced that the better we are at noticing how we're behaving, how we're thinking about how we're behaving, the effect we're having on someone else, all simultaneously, that's some next level stuff. Much less when you're just learning the words to say and the things to try and what have you. I think if as a brand new BCBA had self-reflected, as much as I can now, or noticed all of that, my head would've blown up, right? There's so much coming at you. You have to get good at a part of it and then good at the next part, and the next part. I think that's really where a supervisor can help you. Sometimes even senior sessions, they're gonna notice stuff that you didn't, and they can add in. Maybe they'll notice things about your behavior, they'll notice things about let's say that family or the staff person was responding to what you did. They can really describe, “I saw this and then this happened”, and even prompt that perspective taking of, “Why do you think that might have happened?” One of the ones that I really like is flexibility and compromise, and it's one that can be particularly hard when you are simultaneously struggling with, “This is hard and it's new. It's really important that I be right, because I don't want to make mistakes,” and someone is disagreeing with you. Certainly, early in my career, and even now many times, this is an area where I have to shake it out [Laughing] and get flexible. I don't want to be a super twister, but I gotta be a little bit more flexible and recognize that anytime you start thinking about, “One of us has to be right or win,” everybody has lost.

Dr. Tyra Sellers (16:40):

Yeah.

Dr. Linda LeBlanc (16:41):

That powerful reminder that compromising isn't a dirty word. It's making reasonable concessions in a way that's agreeable to everyone. I think it takes us a while, and sometimes even a few times where we maybe didn't compromise when we should have, and seeing the effects that you can decide, “I don't need to compromise,” but you can only decide that so many times, and then you're out of the game. You're not part of the decision making anymore. That notion of, “Well, when is it okay to compromise?” Particularly when you're working with a family, what I say is, “Almost always,” because it's not your kid. You are discretionary, you are extra and you have to protect your opportunity to have influence and give support. You are not the boss of other people's lives. You're barely the boss of your own [Laughing].

Dr. Bridget Taylor (17:45):

That speaks to the communication skills, right? When I am working with staff and helping them learn how to compromise, it's all about how they engage in that conversation with a parent. I can give you an example of a family early in COVID, who was really struggling with the idea that their child would wear a mask. We had mask mandates at the school and staff were really digging their heels in. They were ready for a fight when it came down to having the conversation with the parent and I put the lead in the conversation and modeled for them that you have to listen to what the concerns are. [Laughing] Part of communication skills is to, like you say Linda, pay attention. Let's give space to the parent to voice the concern. Let's give space for us to understand why this is such a concern for them. You're not gonna meet in the middle until they have an opportunity to fully express all the reasons of concern and allow the room for us to just hear them out. So much of that, being able to compromise, really comes down to those vital communication skills, active listening, being able to paraphrase back, “I hear what you're saying. You're really concerned that a mask will stifle his breathing, and you're concerned about his asthma.” Really what the concern is, and I can tell you, it just takes the air out of the room when somebody is listening, and you can see the parent's shoulders just relax.

 

Dr. Linda LeBlanc (19:26):

Because they came ready for a fight too. 

Dr. Bridget Taylor (19:27):

They came ready for a fight too, and they want a powwow with us and it's just like, “Oh,” and then everything's just a little bit easier. We may not get a hundred percent of what we want, and we made a real nice compromise where it was like 30 seconds of practice and then slowly build over time and monitor with the nurse. She wanted a couple of other programs to be taught. Instead, we compromised on that, but that doesn't come by just saying, “Okay, we're gonna compromise.” It's like, “Let's hear your concerns. Let's hear what this is about.” Getting down to really helping the family to feel heard and listened to.

Dr. Tyra Sellers (20:11):

What I love about that example and just generally that idea, Bridget, is that what you're teaching your staff is to listen so that they learn not to listen, so that they can prepare their response or their rebuttal or their argument. You're listening to learn, “How do we meet a common goal,” not “How do I convince you to take my position?” That’s a powerful thing to learn how to just listen without judgment and be open to learning something about that other person and their perspective, even if it doesn't change your mind. That's not the point, right?

Dr. Bridget Taylor (20:54):

That's right, and never in history have all of us had to become better listeners when we're dealing with vaccination. People who don't want to be vaccinated and you're running companies or people. It's been really hard to compromise on some of these issues. Listening becomes vital to keeping those relationships really solid.

Dr. Tyra Sellers (21:13):

Yeah.

Dr. Linda LeBlanc (21:13):

The way that you compromised, is not like you compromised with, “Then nobody wears a mask. It'll be great.” You compromised with, “Well, you know what? What we do is teach and you're saying this is gonna be hard for him, and that you're concerned about asthma and how uncomfortable he will be. Let's start working on teaching and monitoring.” You didn't compromise outside of the realm of something reasonable, behavioral, potentially effective, or that we're gonna take some data and see how it goes. I think that's when I say it could be okay to compromise almost all the time. I'm not saying you have to say, “Well, let's not do behavior analysis. We're gonna do Reiki.” That's not the compromise we're looking for, but there is so much room to be flexible, to listen, to address that within the framework of compassionate behavior analysis.

Dr. Tyra Sellers (22:31):

It seems to me, as you were saying that, Linda, and reflecting on Bridget's example, the idea is almost the compromise is less on the ultimate goal. Both parties, in your example, Bridget, the goal was to keep this individual safe and healthy and happy. The compromise comes in the process or how you go about meeting that goal. Often, we can compromise in our processes in a way that honors things that feel good, that maybe feel more dignified, maybe feel kinder or gentler. I really love that idea. It's not like we're compromising because I'm gonna give up my ultimate goal. I hear your concerns, and I want to make sure that all of our concerns are met to the best of our ability.

Dr. Linda LeBlanc (23:25):

Yeah. Well, interpersonal relationships matter whether it is your coworker, your supervisor, or your supervisee, your someone in another discipline, it all matters. The notion of, “I will be able to accomplish more for myself and the people I serve, if I use my skills to better communicate, engage, understand, and collaborate with other people regardless of who they are.” The idea of uniquely collaborating with families in the context of the care we provide is something that's close to my heart. I know it's close to your heart because we've had the opportunity to collaborate on a couple of papers. When we were collaborating on this, every meeting Tyra, you should have been there. [Laughing] It just was this conversation about this and so many ideas, so much understanding of the importance, but also maybe this concern that we're not yet knocking it out of the ballpark in terms of our practice, and that we have to understand the importance of this. Part of writing those papers was to convey to other people, right? This is important, this matters, this could change your outcomes, and this is a little bit of how to do it. You really handled a lot of the “here's how it works” in other healthcare fields”. This is not just our crisis. I'm not trying to be all judgey and blamey about behavior analysis. This has absolutely happened in healthcare professions. It's now a mandatory part of medical training, that you have empathy and therapeutic relationships and connecting with your patients. It's not just okay to have a crud ball bedside manner anymore.

Dr. Bridget Taylor (26:01):

Even though that still exists.

Dr. Linda LeBlanc (26:03):

[Laughing] Yes. It's not okay, but it definitely still exists.

Dr. Bridget Taylor (26:06):

[Laughing] Yeah. When you and I embarked on this project, I started looking at who was doing work in this area. It's really clear that other healthcare industries are interested in this topic and really see it as essential. Being trained as a psychologist as well, you get training in that therapeutic relationship building. We understand the importance when it comes to helping people make changes in their lives. In medicine, we know that it can improve patient care experience, although these are based on rating scales and behavior analysis might have problems with the data measures. Nonetheless, patients are reporting improved, reduced anxiety at office visits, and improved quality of just the care, is judged to be much better when the doctor is interacting with them in a way that's compassionate, empathic, and that leads to better adherence and then potentially better outcomes. It's a small, but statistically significant meta-analysis that have been conducted, nonetheless seems to indicate that when doctors are interacting with patients in a particular way, it can in fact affect outcomes, if people are adhering to their prescribed, medical regimens.

Dr. Tyra Sellers (27:26):

Yeah. I was just gonna say, and we know that adherence is often an issue in our profession.

Dr. Bridget Taylor (27:32):

Correct. Yeah, and that's an interest of mine of late. Really looking at what some of the variables are that contribute to adherence to treatment. We still have a lot to learn about that.

Dr. Linda LeBlanc (27:48):

We did the first paper where we surveyed families about some of their experiences with their providers. There clearly were some aspects of compassionate care where we did well and others where we were not rated as doing so well. Here's the big picture theme: We're great at focusing on that kid, but not necessarily at really fully embracing this family as our client. Asking how they're doing, asking what they value, ask those kinds of things. It's not even gonna cross your mind if your mindset is that this child is my client and they somehow exist separate from that context, of their family.

Dr. Bridget Taylor (28:43):

Yeah. I think a theme that came up again and again in the survey was communication and the importance of communication, and the value that they placed on being communicated with regularly about changes in programs and changes in treatment, in therapists and so on. Wanting to know more information. I think that was a real take home for me that parents just really want information.

Dr. Linda LeBlanc (29:08):

They do and they don't necessarily want to look at graphs. That graph might be a good tool to communicate, but they want to communicate in ways that they know how to communicate. They want to hear in a language that they understand. If we equate communication is data sharing, we might try to communicate in ways that are a little bit aversive or jargony, and they feel like we're not communicating, even though we are like, “But I'm sharing the data. I'm communicating the best way I could.” That’s maybe a great way to communicate with other people in the field, but maybe not with a family who's wanting information in a digestible, acceptable, understandable form.

Dr. Tyra Sellers (30:02):

Yeah. I don't want to interrupt you, Bridget, but I was just wondering if you have examples for maybe how folks can address that? For example, do you suggest that people, early on in their relationship with caregivers, just say, “How do you like to get updates? Are you an email person? Do you love graphs?”

Dr. Bridget Taylor (30:30):

Yeah. I think sometimes we think too hard about these things and what we really need to ask ourselves is, “What would we want?” We want somebody to ask us what the way is we would want to be communicated with. Really helping clinicians to understand the importance of engaging families, by asking questions and finding out what's important to them. Even in looking at how they might think they learn best. What's gonna work for you? Is video working? We found out during the pandemic, when we switched to virtual, that many families did a lot better during our virtual parent training sessions than they did when we were working directly with them, and that was a really interesting phenomenon. It was purely anecdotal. I don't have any data to support it, but parents were reporting appreciating our training and I think because it was so much more focused, right? We were there on the computer with them. I think you're absolutely right Tyra, which is asking families what kinds of communication is important to them. Unfortunately, we're in this industry now where everybody's really concerned about time management because of the billable hour, and sometimes we don't make time that we should be making with families. If we don't make the time, if we're too concerned about the billable hour, it's really going to impact our capacity to have relationships with families. We can ask those questions if we don't make the time. I think setting up opportunities to find out what's going to work for the family is really vital.

Dr. Linda LeBlanc (32:05):

Yeah. I don't think data is bad. Let's be clear about that. I love some data, but whenever I share data with a family, I am not showing them the same kind of data that I respond to. It's a much higher level of analysis, might be some bar graphs, and it's usually to support a point. For example, I might be talking about the fact that your child's been learning a lot of skills. Here's how many new targets mastered per month, but here's the cool thing: He's learning how to learn faster. Here's how I know, here's a little graph going down that means less times to get it right. I don't need to tell 'em about a X and Y axis, but that visual is gonna support the way that I am conveying what the progress has been or the concern. Whereas we are much more likely when we're talking to other professionals to lead with the graph, orient 'em real quick and then dive deep, and in this data point and that data point, and without all of shared technology and science and background. That's just not gonna be the right way to go.

Dr. Bridget Taylor (33:32):

When we have our clinic meetings, we'll pull up graphs on the smart board and we really have to pause to explain to families what we're looking at. They learn, of course. Don't underestimate a parent's capacity to learn, but I think sometimes we just assume everybody in the room understands what we're talking about. I think taking the time to just say, “Okay, here's what we're looking at, but here's what it means.” The reverse of that is having families be able to tell us what data collection systems work for them at home. We've had to modify and just do a rating scale of how his behavior was tonight on us. One, two or three: It was great, not so great, really awful, because it was so cumbersome for them. I think we need to be able to adapt our technology, to meet the needs of families. Sometimes we might get so caught up and it's gotta be this precise data for us to really know whether the behavior's going down or going up. I think we want to make sure that we modify our procedures so that families can be flexible, right?

Dr. Tyra Sellers (34:45):

Yeah. I was gonna say flexibility and compromise for the win.

Dr. Linda LeBlanc (34:49):

[Laughing] It comes right back around. We also worked on a second paper, and it really confirmed for us that the outcomes that we're getting are a product of the learning experiences that people have. We also surveyed practicing behavior analysts about their graduate training and some of these behavior analysts also had backgrounds in other disciplines, whether it was counseling, SLP education, whatever. We asked them a little bit about their graduate training, the academic, the practicum, and then postgraduate experiences in this area of compassionate care and therapeutic relationship skills. Guess what? We get what we paid for, right? [Laughing]

Dr. Bridget Taylor (35:50):

That's right. We found most, as could be predicted, had not had training in these skills and some were getting them in mentored experiences, which is hopeful, because I think since we started working on this in 2018, there's definitely been a sea change. I tell people when I talk about these papers, that it's gonna be obsolete. Eventually, we can't talk about this paper anywhere because I think things are changing for the better, which is terrific. The paper did show that the survey showed this is not being taught in graduate training programs as to be as predicted.

Dr. Linda LeBlanc (36:28):

We also looked at the assigned readings, or we didn't, there was another article that did, and there wasn’t any. How can there be assignments if there aren't papers that are clearly focused on this? Part of what we were hoping to do was just get some things out there that could be assigned and then let's see what we get. Maybe there will be 5, 6, 7 papers that occur over the span, such that you could have a section of a course that really focuses on these skills. 

Dr. Bridget Taylor (37:10):

We're starting to see more of that. I reviewed a paper where they did clicker training. The author is escaping me now… I'm gonna find it. There are people doing work now to see if we can train these skills.

Dr. Linda LeBlanc (37:30):

You're saying they did clicker training for the therapeutic, interactive listening or whatever skills?

Dr. Bridget Taylor (37:38):

Yes. We're starting to see more focus on this. We've sat on a couple of dissertation committees, Linda, and I'm excited because I think more people are showing interest in this, but it is an empirical question. Whether we can teach these skills. I think we can look at the field of medicine and other areas of psychology, healthcare where you can teach people to engage in certain responses like paraphrasing body language. That's been a big thing in medicine. There is no discipline better than ours to operationalize these responses, put them out there in a measurable way and then developing those training curricula, and then empirically validating those curricula to demonstrate that people can in fact learn these skills.

Dr. Tyra Sellers (38:35):

I totally agree. It reminds me of the trajectory the profession is taking with regards to things like cultural responsiveness, where everybody agrees that we need it. Some people think they're doing really great at it, but most of us never got any instruction in it. Now, there's more scholarly work coming out in that area. 

Dr. Bridget Taylor (39:02):

The people who were doing clicker person, it's one of Evelyn Gould’s students and she is a co-author. That, I remember. It was a demonstration of using clicker training to shape up some therapeutic relationship skills in the context with people who were role playing interaction. People are starting to do work in this area.

Dr. Tyra Sellers (39:22):

I actually love that because the clicker is a minimal disruptor to the kind of flow of the interaction that's going on. I also worry and wonder if the two of you have thought about this: The phenomenon that happens where we often rate our competence and are more confident than our skills actually are. I wonder if that happens, to some degree, when it comes to things like interpersonal communication skills and compassionate care, and maybe some of us think we're doing better than we really are.

Dr. Linda LeBlanc (40:01):

It's possible and it's always a bad place to be when your confidence exceeds your confidence. I will say in the context of supervising others and so many new people in the field, for many of them, they have not even been thinking about this. When they hear about the ideas and the strategies and how they might think about it, it intuitively feels wonderful, “Great. Yes. I want to do that.” For many of them they could immediately recognize like, “I maybe didn't say that the right way.” For some, they might not, and I think that's something that we need to think about. If in fact, we purport, we posit that these skills are critical to your success in behavior analysis, and especially in applied behavior analysis where you are in human services, working with clients with families. There are some folks who come into our field, and they have a strong interest and motivation, but they don't have great interpersonal skills. They don't have great perspective taking. It's not just that they haven't thought about, “I should try to embrace the perspective of the parent.” They don't have great perspective taking skills for anyone else. For me, it can be hard to move the needle on that. It's one thing to build upon pretty decent interpersonal skills, but to really hone them and refine them in the context of a therapeutic relationship. I want to hear from you guys too about this. Should we be selecting for interpersonal effectiveness and interests in having relationships with people as part of our recruiting? I do think for a lot of our programs, they want to recruit scientists. It's just that many of those people then become practitioners and this notion of really having compassionate relationships with family might not have been part of the game plan for them.

Dr. Bridget Taylor (42:54):

Yeah. I think it's really important that providers look for those skills, if they're able to identify them on interview. I did a couple of interviews today, actually, for staff for our school program. I was struck by the variety in that level of engagement. We're in masks doing interviews and it's awkward to begin with. You can't read facial expressions very well, but it was very important to me that when I asked certain questions about what it is that you like about working with kids, that they spoke to the relationship. How much they like to interact with people with disabilities and how they feel doing it, whether they had an understanding of a family's perspective. Those are things that I ask on interview. It does matter to me. It matters to me how they answer. If somebody seems completely devoid of that and doesn't seem to have an understanding of what it might be like, they don't have to be experts because they're not. These are paraprofessionals and they’re like RBTs. They're coming in, they're doing the work. I'm looking for something other than just that they can tell me that they can do discrete trial teaching. What is in the relationship there between you and the child?

Dr. Linda LeBlanc (44:24):

Do you also look for that with, let's say, hiring a new BCBA?

Dr. Bridget Taylor (44:29):

Yeah, absolutely. We recruited someone recently and BCBAs are really hard to come by these days. [Laughing] Let's face it, we're all struggling to hire, but I was so delighted when I met her because of her interpersonal skills. I didn't hire her. One of my directors hired her, but I was really happy with how she presented herself. I, right away, sent a text and said, “You picked a good one.” She was just so comfortable talking about the work that she does and how much joy she gets out of the work that she does. They're subtle, and it may seem metaphorical that we're talking about these relationship skills, but they're there. You know them when you see them. [Laughing]

Dr. Linda LeBlanc (45:12):

You sure do and they don’t replace the other skills. You can be nice all day long, but if you don't know the basics of how to design programming and to use behavior analysis, to create positive effects, that's not gonna be a winner, winner, chicken dinner either. [Laughing] You really have to have the foundational skills for both of those. I also think the same thing is true in being a supervisor.

Dr. Tyra Sellers (45:49):

Absolutely.

Dr. Linda LeBlanc (45:50):

It's not only that we have to work to teach our students, practicum employees that are working with families this, but you have to bring exactly those same skills to the supervisory relationship and to have that perspective taking of what it was like for me when I was a brand new penny and was just nervous that I wasn't gonna get it right, or just didn't even have that additional perspective on how the world perceived me and to have some compassion. Also some, “This is my job too,” that if you really are going to be someone's supervisor and they really are going to be supervising others or providing care to families, helping them develop these skills is part of taking that full responsibility as a supervisor. 

Dr. Tyra Sellers (46:58):

Absolutely. I think that circles back so much of my favorite core, interpersonal skill that we talked about earlier that I ripped away from Bridget of noticing, and self-reflection, because I think to be a good clinician, but to be a good supervisor requires that. You have to attend to your own behavior and be able to discriminate. Why did I change my tone of voice in that interaction? Why did I choose that word instead of that word? Why did I engage in this thing differently? You have to be able to describe that. You have tact it for folks, and then you have to try to teach other people how to do that. It's really, really flipping hard.

Dr. Bridget Taylor (47:46):

I think that the idea of perspective taking is really important when you're teaching BCBAs to supervise RBTs or physicians who are paraprofessionals on the ground doing the work. I think what happens in our field is people move into supervisory positions very quickly because we have a shortage of BCBAs. They're moved into a position where now they're supervising staff and they may not have a full perspective of what it's like, because they may not have been in the chair as long as we might have wanted them to be. It does require some pause and reflection for them when a clinician, or an RBT might be struggling with teaching. It's not only knowing the technical aspects of problem solving, but what that experience might be like for the RBT. What it is like for them to feel unsuccessful and having that level of compassion and providing that support to them.

Dr. Linda LeBlanc (48:48):

That needs to inform how you communicate to them. In a prior podcast, we were able to talk with Dr. Florence DiGennaro Reed about feedback and the notion of anchoring the feedback you are giving to how you can be effective and feel more confident and have the positive impact that you want with this client. If you're not engaging in that perspective, taking when you are supervising and giving that feedback, it can pretty quickly come across as, “You need to do better, because I want you to do better.” [Laughing] That may be true, but in fact, that's not gonna be inspiring to anyone and you are going to have a bigger impact on their behavior. If you can describe this certain thing seems to be having this effect on teaching, “I'm gonna offer you an idea that might change that a little bit and get this child responding more quickly, differently. Can we try that together?” It really anchors it to the fact that number one, I've just communicated, “I trust your intent that you want to be good and do good. I'm communicating to you my intent that I care and want to help you be good and do good and that we're in this together. This isn't just a “You step up your game,” which even when you're not saying that a person who doesn't know how to please you yet might hear it that way.

Dr. Tyra Sellers (50:37):

Yeah. I often reflect on something similar when you're thinking about addressing individuals that have persistent performance issues, and you haven't been able to get the change that you're looking for. I think even just acknowledging, “Hey listen, Bridget, it's gotta feel frustrating for you to continually try to do what you think I'm asking you to do, and you must feel like you're not hitting the mark. I'm really sorry. Let's work together to see how we can come up with a better description or a better plan for us to make the change that we need.” I just think even making that acknowledgement can really go very far.

Dr. Linda LeBlanc (51:21):

Well, there is clearly a lot of great work to be done in this area. Not only in research on interpersonal skills, but in teaching these kinds of interpersonal and therapeutic skills, relationship skills to our new behavior analysts. We've not had tons of great instructional resources, but the article that we published had a proposed curriculum. Guess what? Bridget and I are gonna practice what we preach. Coming down the road from ABA Technologies, we are going to be creating some instructional CEUs so that any behavior analyst who wants to learn more of these skills. The best thing is to have a master as your boss. So go work at Alpine [Laughing], but if you don't happen to…

Dr. Tyra Sellers (52:19):

Okay, I quit. I'm gonna go work there right now.

Dr. Linda LeBlanc (52:22):

[Laughing] That's right, but if you don't have enough Bridget Taylor in your back pocket, you could at least have her on your screen. Along with me, talking through each of these skills and presenting examples and non-examples and activities to let people be able to access a curriculum for these kinds of skills. I know that's gonna be fun, and I can't wait for us to have that out. It's really a passion project for us.

Dr. Bridget Taylor (52:57):

That's right. I think the field is really wide open when it comes to this work, so any of you who are listening, if it interests you there's much more work to be done in terms of empirically validating training programs. Get to work in this very important area.

Dr. Linda LeBlanc (53:16):

[Laughing] Well, thanks everybody for joining us on this episode of The Lift. Tyra mentioned, all of this stuff is hard, and that's part of why we call this podcast, The Lift. It is effortful, but this is how we raise the field together and focusing on these kinds of important skills, and also focusing on teaching new behavior analysts these skills, that's how we raise the game. We raise the level and we move towards the kind of impact we want behavior analysis to have on the field. Thank you, Bridget, for joining us.

Dr. Tyra Sellers (53:58):

Yes. 

Dr. Bridget Taylor (53:59):

Thank you, Linda, so much. Thank you, Linda and Tyra, it's been a lot of fun. Thank you so much. Great topic and great podcast.