According to the National Institute of Mental Health, nearly one in five adults—46.6 million—in the United States is living with a mental illness.
From living with mental disorders like anxiety or depression to coming to terms with traumatic incidents like physical trauma, illness, or the death of a loved one to coping with daily life, Americans turn to psychotherapy to alleviate or control symptoms, increase feelings of well-being, and function better, both in society and personally.
Behavior analysis has become a widely accepted and used treatment in the field of psychotherapy and its practical applications have broadened in recent years. While traditionally used for children with autism and other developmental disabilities, the evolution of applied behavior analysis (ABA) has allowed a variety of practitioners in the human services field to utilize it when helping both children and adults learn new behaviors and eliminate undesirable or problem behaviors.
What is Psychotherapy?
Psychotherapy—or talk therapy—is an extensively studied, widely accepted form of treatment for individuals suffering from psychological disorders, social disorders, and mental illnesses. Often combined with medications, lifestyle changes, and other therapies, psychotherapy utilizes one or more modalities or techniques to alleviate suffering and achieve healthy functioning for patients with mental health problems or emotional difficulties.
Psychotherapy is actually an umbrella term for a variety of talk therapies performed by a variety of trained professionals such as psychiatrists, psychologists, social workers, behavioral therapists, counselors, and licensed therapists. Psychotherapy may be conducted with an individual, a couple, families, and even in group settings, and with children, adolescents, and adults. Psychotherapy can be broken down into two, major types of therapies:
- Psychoanalysis
- Behavior Therapy
Psychoanalysis
Developed in the late nineteenth century, psychoanalysis seeks to uncover psychological issues by bringing suppressed (unconscious) feelings to conscious awareness. It is the position of psychoanalysis that past experiences and events, even when forgotten, continue to live on in our psyches, often negatively affecting our current behaviors. Only when patients begin to recognize these past events and experiences can they begin the healing and recovery process and make positive changes in their lives.
Unlike many other forms of psychotherapy, psychoanalysis is often a long-term therapy, with patients exploring their pasts in a naturally unfolding process. And unlike behavioral therapies, which have clear parameters for treatment, including specific time frames, psychoanalysis is a truly personal experience between the patient and the provider with few rules and an open-ended course of treatment. It isn’t unusual for psychoanalyses to last for years (or even decades). Psychoanalysis is often viewed as a conversation between patient and therapist, with self-understanding and self-recognition being the overreaching goal.
Psychoanalysis may include focusing on the expression of one’s emotion; identifying recurring themes and patterns; discussing past experiences; and exploring past attempts to avoid distressing feelings, although patients are generally encouraged to speak about whatever comes to their minds, thus allowing the unconscious to reveal itself.
History of Psychoanalysis
The creation of psychoanalysis is largely attributed to Sigmund Freud and Josef Breuer, who studied treatments focused on helping patients recalling traumatic memories and later published Studies on Hysteria in 1895.
Freud’s work continued, and in 1896, he coined the term ‘psychoanalysis’ to describe the ‘free association’ therapy approach, which involves uncovering repressed memories by allowing patients to speak freely and then analyzing what they say. Freud expanded on the concept of psychoanalysis in the years that followed, exploring issues involving sexual trauma and mental health and the interpretation of dreams (which included a book of the same name in 1899).
The early twentieth century brought a flood of progressive thinkers to the field, including Alfred Adler, Otto Rank, and Carl Jung, all of whom began to refine and expand on psychoanalysis.
Contemporary psychoanalysis is often a blend of both Freud’s original findings (called Freudian, or classical psychoanalysis) and related theories (including interpersonal psychoanalysis and self-psychology).
Behavior Therapy
While psychotherapy seeks to examine our past experiences to determine the source or cause of unhealthy behaviors, behavior therapy removes any assumptions that a patient’s behavior is the result of unresolved past issues or experiences and is instead based on the concept that all behavior is learned. And because behavior is learned, it can be re-learned, with positive behaviors replacing negative or unwanted behaviors.
This form of therapy is much more structured than psychoanalysis, with specific protocols used to achieve the desired results. As such, courses of treatment are usually shorter.
Behavior therapy is based on the theory of behaviorism, which says that all behaviors are based on interactions with the environment (called conditioning). Through one or more behavior therapies, patients are taught to learn positive behaviors and abandon negative ones. Behaviorism has become a widely utilized form of therapy for children, adolescents, and adults in a variety of settings.
Behavior therapy is a broad term used to describe a number of proven therapies related to behaviorism. The three most commonly utilized therapies in the field of behavior therapy are:
- Applied Behavior Analysis (ABA) – Involves learning or relearning positive behaviors through positive reinforcement
- Cognitive Behavior Analysis – Involves recognizing negative or destructive patterns in behaviors and then incorporating therapies that replace them
- Dialectical Behavior Therapy – Involves recognizing negative feelings and incorporating coping strategies to manage them; most often used with patients with borderline personality disorder or severe depression
History of Behavior Therapy
Around the same time Freud and his colleagues were studying psychoanalysis, another group of scholars and psychologists were studying the link between the environment and behavior. B.F. Skinner was the largest voice in this field of study, developing the first behavior evaluation and intervention treatment he called the ‘functional analysis of behavior’ in 1938.
Behaviorism and the therapies that resulted are largely based on two schools of thought: classical conditioning (linking two stimuli together to produce a new learned response) and operant conditioning (reinforcing positive behaviors while allowing negative behaviors to die out), and today, practitioners utilize both when implementing strategies related to behavior therapy.
What Exactly Do Psychotherapists Do?
Psychotherapists are mental health professionals who utilize psychoanalysis and/or behavior therapy to treat patients.
In addition to delivering direct patient care, psychotherapists are responsible for assessing and diagnosing patients, developing appropriate courses of treatment, and assessing patient progress throughout the course of treatment. Psychotherapists also often collaborate with other professionals (mental health professionals, educators, parents, medical doctors, social workers, etc.) to develop and implement a course of treatment for their patients.
How to Become a Psychotherapist: Degree, Certification and License Requirements
Psychotherapists may be psychiatrists, psychologists, therapists, social workers, child or marriage/family therapists, or professional counselors, and they may provide psychotherapy services in a variety of settings, such as social settings, private therapy settings, hospital settings, and educational settings.
Psychotherapists may or may not be state licensed, and their qualifications often vary based on their title or role. This is because psychotherapy may be carried out by a number of qualified professionals with titles such as:
- Psychiatrist
- Clinical psychologist
- Child psychologist
- School psychologist
- Psychoanalyst
- Licensed professional clinical counselor
- Licensed clinical social worker
- Marriage and family therapist
- Behavior analyst
- Behavior therapist
- ABA therapist
- Behavior clinician
- Behavior specialist
- Board Certified Behavior/Behavioral Analyst (BCBA)
Education and Licensure/Certification Requirements
With the exception of psychiatrists and psychologists, both of whom are doctoral prepared and have specific post-doctoral experience and whose titles are protected through state licensure, a master’s degree in psychology, counseling, behavior analysis, or a related field is the most commonly pursued course of study among psychotherapists and is a standard requirement for most state licenses and professional designations through nationally recognized certification bodies.
Counselors, social workers, and behavior therapists can all practice independently in all states with a master’s degree and the proper state or national credentialing:
- Social Workers (MDW, DSW, PhD) graduate from bachelor’s, master’s, or doctoral degrees approved by the Council on Social Work Education; social workers must have two years post-degree experience in social work and pass an examination through the Academy of Certified Social Workers.
- Professional Counselors (MEd, MA, MS, EdS, PhD or EdD) must have a master’s or doctoral degree from an accredited college or university, must complete specific graduate training in counseling, and must pass an examination through the National Board of Certified Counselors.
- Behavior Therapists (MA, MS, PsyD) graduate with a master’s or doctoral degree in behavior analysis, education, psychology from an accredited college or university. Most behavior analysis earn the Board Certified Behavior Analyst (BCBA) certification, either as a requirement for state licensure or as a voluntary professional designation. To achieve BCBA certification, applicants must earn a master’s or doctoral degree in behavior analysis, education, or psychology from an accredited college or university. The degree must include acceptable graduate coursework in behavior analysis and must include a defined supervised practical experience. Applicants may also qualify by completing a master’s degree with a verified course sequence. Qualified applicants must then pass the certification examination to earn BCBA certification.
Master’s degree programs related to psychotherapy may include:
- MA/MS in Psychology
- MA/MS in Clinical Counseling
- MA/MS in Clinical Psychology
- MA/MS in Organizational Psychology
- MA/MS in School Psychology
- MA/MS in Counseling Psychology
- MS in Clinical Rehabilitation and Mental Health Counseling
- MA in Counseling and Guidance
- MA in Counseling or Mental Health and Wellness
- MA in Addiction Counseling
- MSEd in Clinical Mental Health Counseling
- MS in Behavior Analysis
- MS in Applied Behavior Analysis
- MS in Psychology – Applied Behavior Analysis
- MS in Psychology – Behavior Analysis and Therapy
- MSEd in Applied Behavior Analysis
- Master of Applied Behavior Analysis
- MS in Special Education, ABA concentration
- MA in Psychology, Behavior Analysis specialization
- MS in Behavior Psychology
While these degrees differ somewhat in their overall curriculum design, what remains consistent throughout is that all offer structured supervised experiences. Many programs prepare students to achieve specific national credentials, and many are designed to adhere to state licensing requirements, so it is important for students to carefully choose the appropriate degree.
Choosing an accredited program is a smart first step:
- The Council for Accreditation of Counseling and Related Educational Programs (CACREP) accredits both master’s and doctoral programs in counseling.
- Association for Behavior Analysis International (ABAI) accredits training programs in behavior analysis at the bachelor’s, master’s, and doctoral levels.
- The Council on Social Work Education (CSWE) accredits bachelor’s and master’s programs in social work.
State Licensure Requirements
The following sites provide details on the requirements (if any) to practice psychotherapy in your state:
- The American Counseling Association provides state-specific information on licensing requirements for counselors, mental health counselors, family counselors, marriage/couple counselors, and addictions counselors.
- The American Counseling Association provides licensing information specific to school counselors, who are licensed through their state departments of education, separately from other counselors.
- The Behavior Analyst Certification Board provides links to each state’s regulatory board website for information on licensing requirements for behavior analysts.
- Three states currently license psychoanalysts: New York, New Jersey, and Vermont. The National Association for the Advancement of Psychoanalysis provides detailed information regarding state licensure requirements.
- Depending on the jurisdiction, social workers may be licensed at the bachelor’s, master’s, and/or doctoral levels. The Association of Social Work Boards maintains updated information regarding each state’s licensing requirements.
Salaries for Psychotherapists
The U.S. Bureau of Labor Statistics (BLS) provides an overview of what psychotherapists are earning, as of May 2021. The following statistics provide average salaries for psychotherapists at the 25th, 50th, 75th and 90thpercentiles:
- Healthcare social workers: $47,630, $60,840, $76,920, $86,820
- Social workers, all others: $46,340, $61,190, $80,040, $93,540
- Substance abuse, behavioral disorder, and mental health counselors: $38,520, $48,520, $61,660, $77,980
- Educational, guidance, school, and vocational counselors: $47,390, $60,510, $77,210, $98,190
- Counselors, all others: $37,060, $45,160, $58,090, $76,780
- Therapists, all others: $46,980, $59,500, $77,830, $98,490
- Marriage and family therapists: $42,910, $49,880, $75,410, $96,520
- Medical and Health Services Managers: $77,750, $101,340, $135,750, $205,620
- Special Education Teachers: $48,350, $61,720, $82,230, $104,370
2021 US Bureau of Labor Statistics salary and employment figures for Healthcare Social Workers; Social Workers, All Other; Substance Abuse, Behavioral Disorder, and Mental Health Counselors; Educational, guidance, school, and vocational counselors; Marriage and Family Therapists; Counselors, All Other; Therapists, All Other; Medical and Health Services Managers; and Special Education Teachers, All Other reflect national data, not school-specific information. Conditions in your area may vary. Data accessed January 2023.