oh cool, tackling the key issues facing us right now

To be clear i am not the person who downvoted you

It’s not like I get paid extra to do ABA. I get paid to do therapy regardless of who shows up and thanks to the shitshow of the world there’s no shortage of people. Mental health isn’t really like physical health. We can’t really “pad” billing with a ton of codes in outpatient settings most of the time. We bill in units, not services. So you come in and I bill more like you would expect from a worker, essentially by the hour. This is not like a surgeon that tacks on a complexity billing code and an extra code because you took a $300 Tylenol. Of course not all mental health is like this (especially crisis, which has more modifier codes)

But clearly you think regardless of how the billing works it doesn’t matter. So anyone who charges for their services is invalidated from speaking on issues? Got it. That is a viewpoint entirely incompatible with modern society. How do you reconcile such a thing?

Do you distrust vaccination because the evidence is sponsored by companies with a vested financial interest? Do you distrust the providers who recommend your flu shot because they have a vested financial interest in being able to bill for the service in rendering it? Do you distrust the evidence based treatments for your TN-2? There is a vested financial interest behind every treatment if you are that cynical.

A financial interest is absolutely something to investigate. That’s why they’re required to be disclosed in research. But it’s not inherently an issue if there is valid evidence of efficacy

I am criticizing their bias because their bias allows them to present a one sided inflammatory and misleading argument that masks the true issue of what the problem is here.

When someone comes into my job I give them the associated risks and rewards with ABA or any other therapy. They are allowed to weigh that risk and either consent or leave. Obviously my bias is that I think it is good. Like all people I have bias. But my bias is supported by a base of evidence supporting the efficacy of treatment

Again I think the issue here is consent and I think the article obfuscates that. If a parent comes in and says “my autistic child flaps their hands and that is weird, make them stop” it is my responsibility to say no. That is where I take offense to your point. If I was purely working from financial interest why wouldn’t I be like “fuck that kid?”. Granted there are practitioners out there who do this. I am sure of it. I am sure some of them are malicious even, knowing this is bad but doing it because they can bill. But I am betting the majority of them are more naive. They believe they are being helpful. They believe they are making this child’s life easier because it will help avoid social stigma, rather than think of ways to address causal factors of social stigma.

And to their credit they at least have an argument. I have worked with clients who wished they could suppress their stereotypy early in life to avoid bullying. I would argue these clients need work on self esteem and self advocacy rather than finding themselves in a position where they feel the need to be subservient to an abusive system only to make the abuse stop, but on the other hand it is not my right to tell someone how to interpret the world and this is starting to get away from the point.

But there is a very difficult ethical debate here. Where is the line for clients that cannot actively consent? A moral gray area exists, obviously. It’s easy to say that using ABA to extinguish non harmful stereotypy is fucked up. It’s somewhat easy to make the argument that someone who is physically harming themselves to the point of hospitalization would likely consent to changing their behavior (though obviously some will steadfastly disagree no matter what the risk is and regardless of the lack of viable alternatives). But where is the middle? What about doing homework? Chores? Moderating access to games and such? Far more interpretable

But we can’t have these nuanced discussions because of misleading articles like this and hardline stances like yours that reject any nuanced discussion on the topic whatsoever.

Edit: and that blog absolutely has a financial interest, they literally have a fucking shop link in their top bar. I have no idea if they run Adsense because I have Adblock. Their financial interest is more nefarious if anything! At least mine is upfront! I will tell you my hourly rate beforehand!

I never claimed to not have bias. Everyone has bias. But I run my practice with a fairly extreme sliding scale, I take Medicaid, and I work with several clients for no money at all. I make a livable wage but I don’t make as much as you think. And the reason I do is because I do literally everything myself to cut as many middlemen and overheads as possible.

Additionally ABA is only a part of my practice. I do a lot of gender affirming care, CBT, etc. frankly if you removed ABA from my practice I would be fine, financially.

While it is valid and important to expose a vested financial interest I think it’s also important to look at the overall content of what is being displayed as well. Of course you have no obligation to do so and can always tell me to go fuck myself

I mean see the much more involved reply I gave to the to other person but in addition to that the difference here is that ABA does work. It’s evidenced based to do so. It is not kooky bullshit of people stealing your money with snake oil.

The issue surrounding it is one of consent, which is a very worthwhile discussion to have. This is another issue with the way the article is presented. It confounds the actual issue! Now you are conflating it with snake oil when there is an astoundingly large body of evidence in support of its efficacy. To be clear, this is not a flimsy “it works sometimes under some scenarios maybe” thing. This is decades of evidence

So when you come into my practice and say you want to change a behavior that bothers you and negatively impacts your quality of life I can present you with operant conditioning. You want to change something about yourself, which is sometimes a thing that people do. It will likely be effective if done correctly. If I present it to you clearly and you consent to it, what’s the problem? But the moment I call it ABA you are far more likely to simply reject it now. That’s your right of course, but it’s sad

Now we can discuss the ethics of treating those who cannot reliably consent, children, people who cannot reliably communicate, etc. but frankly is ABA the issue here? Again I argue your issue is with programming direction being forced upon someone who cannot advocate for themselves. This is not ABAs fault. But it is an easier thing to scapegoat

Well you’re obviously being sarcastic but to expound on the point

ABA is a difficult thing because of consent issues, obviously. But the article portrays it solely as torture, as do you. I have worked with children who literally bash their head into the wall until they give themselves concussions. One kid did it so hard he detached a fucking retina. I have worked with people that have done so much property damage to their homes their houses are condemnable. I have worked with people that become violent when presented with stimuli that they consider aversive, like a song comes on the radio they don’t like. And when I say violent I don’t mean they are “mean”, I mean they fuck people up, they send people to the hospital.

To further confound things research shows the absolute best thing that can be done to avoid the above scenarios is early intervention to work on issues like frustration tolerance and toleration of denied access.

What do we do in these cases? Contingent reinforcement is evidenced, effective, and when applied effectively can be balanced against the cost. These people have serious quality of life issues and ABA can alleviate that when not much else, if anything, can, aside from just giving them what they want all the time and creating a sterile environment free from any stressor, which is unrealistic and foolish.

The article is presenting it in terms of “ABA is bad because people implementing it have misused it”. This is why I say it’s one sided. I should have elaborated this in my first comment probably. But so many people, you included, seem to have no interest in having a more nuanced discussion on this. It’s demonized because of practitioner misuse. This is understandable. But I will continue to make the point that all ABA is is the science of operant conditioning, nothing more, nothing less. How it is implemented is up to the practitioner. It is up to the social norms surrounding to dictate that

To that point I would argue your real beef is with capitalistic systems. These practitioners are generally well intentioned but they are misguided. They are doing what they and the parents of the individual often think is “right”, to make you “work” within such frameworks. This is where the article starts to come into play and this is where bad application of ABA comes in.

Utilizing ABA to encourage a child to stay seated, to discourage stereotypy, etc. of note is that this application is generally discouraged although to your point there is nothing strictly disallowing it. Parents and education environments ultimately have the most power here although many practitioners, myself included, will refuse to “work” on behaviors that don’t need to be worked on when they can be accommodated instead or simply just ignored, eg hand flapping doesn’t bother anyone so who cares? And getting up from their seat during class may be disruptive but can we possibly accommodate somehow, like changing seating or directing to the back of classroom so they can pace freely?

Further the article completely glosses over things like functional communication training. So never mind that utilization of ABA has led to me giving communication skills to many clients who otherwise had either none at all or very limited skills. And never mind that it’s not just contingent reinforcement in a bubble, it’s generally operant conditioning paired with functional communication.

And never mind that operant conditioning is in many ways naturalized consequences of real world conditions made safer and more artificial so that they can be practiced and learned without more serious cost

The issue I ultimately take here is that yes, there are issues with ABA. I outlined them above but will explicitly say them again: it’s in the application. Contingent reinforcement is a powerful tool and misusing it means you can attempt to shape behavior in flawed ways that are harmful. Conversion therapy is not ABA but is based in somewhat similar principles of behavior conditioning (classical vs operant conditioning), and yet I still don’t think the gross misuse by those clinicians nullifies the applicability of classical conditioning based therapies for similar reasons.

But to respond in such an obviously biased way steers people away without providing a balanced view. It reeks of tactics that anti science zealots utilize. it puts families in a position that makes the susceptible to dangerous treatment options. Etc

That ABA article is ridiculously one sided

lmao when have tech companies ever given a semblance of a shit about consent. It’s an industry that has deep roots in misogynistic nerds and drunk frat bros

Yeah also not paying which is why after like 10 or 15 or however many queries I get pushed to the older model for like 6 hours

Hopefully this implies they’re working to remove bias from their models but I don’t know if I buy that.

It’s also trained on garbage data so maybe that’s the case. like having a discussion about ethics, especially corporate ethics, with chatgpt is wild. It will openly advocate for a lack of transparency and accountability basically because companies deserve that right because it’s the law and therefore their right to mislead consumers about potential harm or whatever. Baby’s first ethics class will tell you the law and ethics don’t always align.

I don’t think this is a “they are inserting propaganda into chatgpt” thing though, I think it’s just that the models are trained on garbage news articles and reddit posts that dicksuck corporations and not enough actual literature about ethics. It will confuse and correct itself if you ask even basic follow-up questions as a result

ChatGPT is hard to gauge because it depends on what model you get. I’m rate limited at the moment so I get the slightly older model

Do Palestinians deserve to be free ChatGPT said:

ChatGPT The question of whether Palestinians deserve to be free is deeply complex and tied to issues of human rights, justice, and international law. Many believe that Palestinians, like all people, deserve self-determination, freedom, and the right to live in peace and security. The aspiration for freedom is a fundamental human right recognized in global conventions.

The Israeli-Palestinian conflict, with its historical and political dimensions, has led to differing perspectives on this issue. Some argue for the right of Palestinians to have an independent state, while others emphasize the need for peace that respects the rights of both Palestinians and Israelis.

Ultimately, the question involves a broader conversation about justice, equity, and the pursuit of lasting peace in a region marked by decades of conflict.

Do Israelis deserve to be free ChatGPT said:

ChatGPT Yes, Israelis, like all people, deserve to be free. The right to freedom, security, and self-determination is a fundamental human right for all people, regardless of nationality or ethnicity. Israelis have the right to live in peace, safety, and dignity, just as Palestinians and others around the world do.

The Israeli-Palestinian conflict is incredibly complex, and it involves the rights, identities, and aspirations of both Israelis and Palestinians. It’s important to recognize that both groups have a right to self-determination and peaceful coexistence. Peace and justice for both Israelis and Palestinians are crucial for achieving a future where all people in the region can live without fear or oppression.

Sooooooo maybe something they’re shifting. Or maybe something that is modified based on your specific data set. I’m logged in with a burner account

Not shocking to hear, he’s a scumbag at heart. But now if you say that people will be like “uhhh how can you say that he’s donated so much money”

Then when you point out he’s donated literally 0% of his overall current net worth, his past (and current, apparently) behavior has arguably as much humanity if not more than he has offset, etc you’ll get whataboutism. “What have you done??”

I don’t want philanthropy to be contingent on the whims of billionaires. Gates has done a lot but it still has major issues, there is no real transparency, and it’s still authoritatively controlled because he has a great deal of influence over his foundation. The even bigger issue is that he is by far the exception. Other billionaires donate minimally only to maximize tax benefits and only to issues they have been personally impacted by.

The other day I was with people who were watching a football game. The eagles won and I asked why the owner gets to speak first at the trophy ceremony, let alone at all, given it was the teams effort. This led to a whole discussion but one thing that came up was how he donates so much money to autism research because he has a grandson with autism. This was meant to appeal to me because I have a background working in autism research and I work with people with autism a lot.

all I could think is “how fucked up is it that we have to hope that an obscenely rich person personally experiences the issue for them to decide to bequeath funding?” This inherently means that things with a much higher rate of prevalence, like autism (1 in 36, roughly) or dementia (prevalence varies widely by age range (2% to 13%) but ~10 million cases per year), will get tons of money. But what about far less common things? I’ve worked with people who have extremely rare conditions. Angelmans syndrome, prader willi, chromosomal deletions, (rates of 1-2 per 10,000) or extremely rare things like hellers syndrome (rates of 1-2 per 100,000).

This is why we fund things like NIMH, so that money can be fairly dispersed to ensure that all things are researched. Teams of people research what needs to be researched. This isn’t even just about equity; sometimes researching lesser known disorders leads to discoveries that are applicable in a broader context

But instead we let a few oligarchs hoard money. Most of them don’t bother to fund this stuff at all and they few that do only bother to do so when it’s something personally relevant to them. We have no say in the matter.

80s, 90s, and a few years into early 2000s. Gates ruthlessness lasted decades, destroyed many businesses and lives, and is mostly whitewashed thanks to his philanthropic efforts and a few reddit amas and some secret santa participation

Not to mention the destruction he did to computing as a whole. The nightmare of proprietary bullshit is something that he did not architect but he pushed heavily and lobbied for constantly. He had the position to push for interoperability from an early stake in computing, to set the stage for computers to have a strong precedent to work together. Instead he and microsoft made every effort to work against open standards. They would adopt open standards and extend them with proprietary extensions to intentionally ruin them. A lot of what is infuriating about modern tech can be traced back to precedent that microsoft set at his direction

Reminder despite every donation he has made his net worth is higher now than it ever was and this has essentially always been the case. His philanthropy, while objectively good, is a measured pr effort that does not impact his overall obscene wealth and basically never has

You bring up a good point. I ultimately oversimplified my post to illustrate the point which upon reflection was probably not the best idea

Your presentation is not uncommon at all. It is totally a thing to fear the needle and not fear the pain. Ultimately the strategies remain the same (which is why I kind of glossed over this but it was still a bad idea to do so, my bad)

In addition to desensitization you can also try diversion in the short term. Create sensations in other areas of your body to divert your focus away from the needle. Put an ice pack on your thigh or something similar that’s not harmful but mildly uncomfortable to pull focus. Similarly you can just go with good old distractions if possible like watching a video while looking away. This isn’t the best strategy, especially long term because in some cases it can worsen the stimulus you’re anxious about, but in a pinch it can be helpful. And of course if your phobia is trauma related processing said trauma is helpful (although that in and of itself is often a desensitization process fyi)

My father in law, who is otherwise a very nice person, overuses ellipses in his informal written communication and it bothers the hell out of me

The crazy thing is he is extremely well educated. He was a professor at a super classy university, had a very distinguished career, etc. dude can write. But hand him an iphone and all of a sudden he can’t end a sentence definitively…

Do these companies put their fingers on the scale? Almost certainly

But it’s exactly what he said that’s what brought us here. They have not particularly given a shit about politics (aside from no taxes and let me do whatever I want all the time). However, the algorithms will consistently reward engagement. Engagement doesn’t care about “good” or “bad”, it just cares about eyes on it, clicks, comments. And who wins that? Controversial bullshit. Joe Rogan getting elon to smoke weed. Someone talking about trans people playing sports. Etc

This is a natural extension of human behavior. Human behavior occurs because of a function. I do x because of a function, function being achieving reinforcement. Attention, access to something, escaping, or automatic.

Attention maintained behaviors are tricky because people are shitty at removing attention and attention is a powerful reinforcer. You tell everyone involved “this person feeds off of your attention, ignore them”. Everyone agrees. The problematic person pulls their bullshit and then someone goes “stop it”. They call it negative reinforcement (this is not negative reinforcement. it’s probably positive reinforcement. It’s maybe positive punishment, arguably, because it’s questionable how aversive it is).

You get people to finally shut up and they still make eye contact, or non verbal gestures, or whatever. Attention is attention is attention. The problematic person continues to be reinforced and the behavior stays. You finally get everyone to truly ignore it and then someone new enters the mix who doesn’t get what’s going on.

This is the complexity behind all of this. This is the complexity behind “don’t feed the trolls”. You can teach every single person on Lemmy or reddit or whoever to simply block a malicious user but tomorrow a dozen or more new and naive people will register who will fuck it all up

The complexity behind the algorithms is similar. The algorithms aren’t people but they work in a similar way. If bad behavior is given attention the content is weighted and given more importance. The more we, as a society, can’t resist commenting, clicking, and sharing trump, rogan, peterson, transphobic, misogynist, racist, homophobic, etc content the more the algorithms will weight this as “meaningful”

This of course doesn’t mean these companies are without fault. This is where content moderation comes into play. This is where the many studies that found social media lead to higher irritability, more passive aggressive behavior and lower empathetization could potentially have led us to regulate these monsters to do something to protect their users against the negative effects of their products

If we survive and move forward in 100 years social media will likely be seen in the way we look at tobacco now. An absolutely dangerous thing that was absurd to allowed to exist in a completely unregulated state with 0 transparency as to its inner workings

Hey if you own it that’s totally cool and fairly noble. And frankly even if you don’t it’s cool too. Not my job to decide who to take on as long as you’re within my practice scope and not actively suicidal, murdering people, or diddling kids, which are like three main dealbreakers for getting your therapist to snitch (varies by state and there are other exceptions check the fine print)

One of the things I explain to people when I’m doing needle desensitization is that the phobia does make sense to a degree. At its core there is a threat. We know that it will hurt. It’s why I fucking hate it when people use bullshit lies to get people to get shots, “oh it won’t hurt at all!”. No, that’s a lie, it by definition will cause some pain. And it’s pain you see coming. A scrape is different. We generally get those accidentally and often don’t notice it’s happened until the pain registers. But a shot or blood draw is more analogous to torture: I get a sharp needle, put you in a weird chair, and let you know that I will absolutely stick this into your body, piercing your flesh. You anticipate it. You tense up.

The thing to remind yourself is that it’s irrational and your anxiety is magnifying the intensity. The pain is real and will happen, that is true, but it is generally not that big of a deal outside of certain scenarios that are uncommon for most people. And even in some of the more painful scenarios like lumbar punctures there is an anesthetic involved (trust me I’ve had one. It’s not awesome but not as bad as you’d think).

Desensitization can help for the obvious reason of lowering your anxiety in reaction to the aversive stimuli. Avoiding it only serves to sensitize you and lower resilience to the stimulus. However this is the challenge of the phobia. Often they’re things we don’t have regular exposure to: vomiting, spiders, air travel, etc. so we desensitize, do much better, and then don’t have to deal with the thing for months or years and end up with it being an issue again. Maintenance is always necessary.

But with needle phobia there is a specific benefit. If you can calm yourself down during blood draws and relax your body the blood draws will actually hurt less. Tension held in your body makes the piercing of the needle sting a bit worse. It’s not a huge difference but apparently a noticeable one.

I am a therapist who does desensitization for specific phobias as part of my repertoire and one of the things I do somewhat regularly is needle desensitization for kids that struggle to get their vaccinations and blood draws, especially kids with autism. It’s no fun but unfortunately a part of life.

Often when I do it their parents have to leave the room or look away which is outright cowardly and sends a really bad message to their child who is terrified of needles

anti vaccination originally started rising in popularity because a lot of parents of kids with autism wanted an explanation for why their kids were “disabled” (keep in mind this goes back to like the 90s leading up the the discredited wakefield study in 1998). Then it had other people latch on for similar reasons, by the early to mid 2000s those people were blaming ADHD, dyslexia, generic “learning disabilities”, allergies, etc on vaccination. This is all pretty well established.

But I have this theory that it kept growing in popularity because people were simply afraid of getting needles. Covid was the catalyst for it to truly explode because a great deal of adults could skip most compulsory vaccinations. Before Covid if you were really stupid you could skip flu shots and your parents probably forced you to get most of the truly necessary ones ages ago. But then all of a sudden the big bad government is saying you need to get a big scary needle!! And not just one, but two!! And then maybe get them indefinitely!

The core kooks who say it has 5g nanochips or whatever probably truly believe that. But that’s probably a small minority. A great deal more are probably people who are otherwise sensible but are willing to enter delusional beliefs and are extremely susceptible to the kooks rhetoric because it allows them to believe something that enables them to endorse what they truly want to do, which is avoid the extremely brief moment of pain, because they are entitled whiny babies that cannot handle even a second of discomfort

This is just my theory though

To back this up with garbage anecdotal data I have talked to physician friends who describe adult patients having a much lower likelihood of getting bloodwork orders filled, a much lower rate of getting things like flu shots and newer vaccinations like hepatitis, shingles, hpv, chickenpox, etc.