The author is an Advanced Line Therapist in Milwaukee, Wisconsin. Applied Behavior Analysis (ABA) is a science which works to increase and decrease targeted behaviors in people. Intensive ABA therapy is a method of treatment for children affected by Autism Spectrum Disorder (ASD). His job presents unique challenges, yet he knows that he is helping his clients lead more fulfilling lives. He finds the work infinitely interesting, though physically demanding and exhausting.

My job is going from house to house within the Milwaukee suburbs doing one-on-one ABA therapy with kids who are on various areas of the autism spectrum.

Each child has six to nine people working with them on a team. The people the child sees most frequently are the line therapists, of which there is an average of four per team. The line therapists are trained to be robotic with the children and use simple cause and effect techniques to determine how to manage the child’s challenging behaviors. For example, most of the programs that we do are administered at “table time”. To begin table time, you are instructed to say “come here” or “it’s table time”, one time only. If the child does not come, the therapist must silently stand up and manually guide them to the table, kicking and screaming as they may be. Consistency is key in this line of work.

Most (full time) line therapists average seven hours per week with four kids, give or take, approximately 40 total hours when you factor travel. When I talk to other line therapists and tell them I do upwards of thirty four one-on-one hours per week I usually get a look of amazement, because they understand the demanding nature of the job.

My usual day consists of three shifts of two to three hours, yet by the time the first shift is over I often feel like I’ve just spent a 10-hour day in the sun (which I know because I used to work 10-hour days in the sun). Following this, and travel time, I find myself arriving at a three-hour afternoon shift already beaten and battered (sometimes quite literally). Part of the challenge to my job is remaining positive, partially because some of the kids are so seriously challenged, and partially because by the time I’ve gotten to that last house chances are I’m on your third cup of coffee and my mind is placed solely on the comforts of your own room. Throughout my time with the company I have realized that the child learns best when they perceive you as fun, and enjoy spending time with you. I am a naturally animated person who unashamedly participated in theater in high school, so I know how to access the extra energy even when I’m already burnt out.

I am an advanced line therapist. Which means I’ve been on the child’s team for a while and have the ability to help train new staff. The longer I’ve worked with ABA therapy, the more I’ve learned about the business side of managing a  service like this one. Turnover is high. More frequently, the position of advanced line therapist is merely relied on by management to complete time consuming paperwork such as data sheets and progress notes in an efficient manner. My position is overseen by seniors, supervisors, and leads. These people make up the members of the child’s team. I’m a recent college graduate, so I don’t have specialty training in therapy or in working with kids on the autism spectrum. While I did have to go through training before beginning my work, the company I work for employs somewhere around 500 people and I am completely replaceable. If I commit to this positi0n long term, there are opportunities for advancement, and I find the work rewarding enough that I may stick around. Despite the exhausting nature of the daily work, it’s rewarding to see kids improve in the way they’re able to interact and express themselves.

Every child has different needs. The rules can be bent or broken depending of the circumstances surrounding each child. For example, I am on the team of one child where we do programs on the floor (as opposed to the table) in context with our play. With this child, there is no determined beginning or end to “work time” as we might call it. With each house you need to go through a mental tally chart in your mind of all the conflicting needs of the child as well as the expectations of family. The day becomes a mental game of whack-a-mole regarding which technique to use while managing a particular behavior.

The work is endlessly interesting. One of the kids I work with engages in a screeching and wandering behavior when undesired things take place. An example of such an event is the internet going out, or the loss of a toy animal. He will put his hands on his ears, protrude an under bite, and stomp his feet widely as he paces around the living room screeching at a tight wavelength. I assume the wavelength of the sound is tight because it is high pitched and rattles the eardrums when done properly by the child. His goal during this bout seems to be hitting this particular wavelength, and using his imagination to escape the situation. Our senior therapist’s behavior plan includes us blocking the wandering behavior so that the child literally cannot wander. The screeching, on the other hand, seems to be a deeper seeded issue. We usually try to give the screeching child incompatible behaviors, like telling the child to say things (such as “I don’t like that”), because you cannot screech when you are talking. We also have many teaching programs in place regarding the use of language.

Overall, my work is challenging, and deeply rewarding. I see the kids make great strides each day. O.K., sometimes it’s just baby steps, but progress is progress and every step counts. I’m working on adjusting my expectations and I’m looking forward to where this experience takes me.

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An individualized approach is necessary for mental health treatment to be most effective. For people seeking to better themselves and improve their mental health, therapy is different for each patient according to their particular strengths and weaknesses. When trying to tackle difficult issues, differences between introverts and extroverts can help clue the provider and the consumer as to what approaches would work best for that case. An introvert will benefit from a different approach to than an extrovert because they tend to communicate and see the world differently.

As more research on the topic is done, extroversion vs. introversion seems to truly be more of a spectrum than two hard line categories. Although some individuals lean very strongly toward one side or the other, everyone has at least a little bit of both. Some people are very close to the middle of the spectrum and need a balance of introverted and extroverted activities in their life and therapy.

Extroverts are easier to understand right off the bat. They tend to be more open about discussing anything on their mind, including their issues and problems. They have less reservations about saying exactly what is on their mind at any given moment. They need to, and often enjoy reasoning their problems and emotions out loud with someone.

It is difficult for extroverts to just sit and listen to their therapist talk. They need to participate and talk things through. They need a counselor to be a good listener who will work through their problems with them verbally and on the spot. As they are talking, often in a stream of consciousness, they start to mull over how they are perceiving situations in their life.

Introverts have unique needs because they are oriented to view life from the perspective of their inner world. Being the minority (about 25%) of people, they may not be understood by the world or not understand themselves very well. Introverts need much less prolonged superficial contact, but they have a strong need for deeper connections overall. They may come off as complicated, but open up to trusted people. In fact, they are capable of a great deal of introspection, profound personal change, and revelations if they are given space. Sometimes, they need to learn how to give themselves permission to take the space they need.

More introverted individuals will naturally gravitate toward taking notes during the session so they can collect their thoughts and come back to certain topics in the following sessions. They need time to think things over in their inner world before they say anything out loud. Introverts will also appreciate a provider who assigns homework, reading, and study they can do on their own. Study and reflection before action is very helpful for these individuals in therapy.

In general, introverted types are also more receptive to meditation. Meditating is a form of introversion: focusing on the present moment and being still in your inner world. For extroverted individuals, it is the last thing they want to do. While both personality types can benefit from mindfulness and mediation, extroverts will need to be eased into it, and perhaps pushed to try it, whereas it will come naturally to introverts. Same goes for getting an introvert to have a difficult conversation with someone. An introvert would rather ignore the problem like it doesn’t exist than step out of their comfort zone to have a confrontation and do conflict resolution. Often, this reluctance persists even when reason suggests it would ultimately benefit them to do so.

It is helpful for providers to figure out whether they are treating an introvert and extrovert and approach them accordingly. Depending on where someone is on the spectrum, different combinations of things will work, so it is good to always check in and see how they are doing with the techniques. Different therapy approaches and techniques will be necessary in order to address their mental health issues.

References:

Diamond, Stephen A. “Essential Secrets of Psychotherapy: Why Extroverts Hate Meditation and Introverts Love It.” Psychology Today. N.p., 10 Aug. 2012. Web. 13 Apr. 2015.

“Understanding Introversion.” New Reflections Counseling. N.p., n.d. Web. 06 Apr. 2015.

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