Can replacing behaviors that don’t work well with those that do allow us to gain more control over our lives? Can we replace old learning with new to change the way we act, feel and think, or the ways in which we deal with external problems?
After almost seven decades of research, behavioral therapists and the medical community have come to think so.
With the blessing of the medico-psychological community behind it, behaviorism quickly gained attention as a respected school of thought, allowing behavior therapy to become widely adopted and used in the U.S. and throughout the world.
What Exactly is Behavior Therapy?
Psychotherapy is defined by the American Psychiatric Association as talk therapy that helps “eliminate or control troubling symptoms so a person can function better and increase well-being and healing.” It can be best broken down into two major therapies: psychoanalysis and behavior therapy.
Unlike psychoanalysis, which seeks to identify the underlying or unconscious reasons why we do what we do (Freud, anyone?), behavior therapy instead looks to the environment, recognizing that all behaviors are learned; in other words, because we learn to develop both normal and abnormal behaviors, we can also re-learn positive behaviors and eliminate negative ones.
If psychoanalysis is grey in terms of its approach to treating patients, behavior therapy is undoubtedly black and white, as therapists use quantifiable measures and a very structured course of treatment to achieve the desired results.
Today, behavior therapies are used to treat children, adolescents, and adults experiencing a variety of issues, including:
- Alcohol/Drug Abuse
- Panic Disorders
- Post-Partum Disorders
- Mood Disorders
- Eating Disorders
Behavior therapy is often used in conjunction with other medical and therapeutic treatments that MDs, psychologists, and psychiatrists prescribe.
The Origins of Behavior Therapy
Behavior therapy has roots in behaviorism, a school of thought that says we learn from our environment.
Behavior therapy itself dates back to the turn of the twentieth century. Most of us know a thing or two about Ivan Pavlov’s dog experiments around this time, which led to the concept of classical conditioning – linking two stimuli together to produce a new learned response. This Russian physiologist found that dogs could be conditioned to drool (conditioned response) when they learned to associate a ticking metronome (neutral stimulus) with food (an unconditioned stimulus).
But the practice of behaviorism didn’t really take off until the work of B.F. Skinner starting in the 1930’s. Skinner is considered to be the father of behavioral modification and behavior therapy, and is credited with developing methods for behavior evaluation and intervention recognized as a ‘functional analysis of behavior,’ which would become the basis for the modern practice of applied behavior analysis.
His work eventually led to the concept of operant conditioning, which involves learning through a system of rewards and punishments. Skinner built on the concept of classical conditioning, but believing it to be too simplistic, went on to introduce what he termed ‘Law of Effect – Reinforcement’, which is the idea that behavior that is reinforced tends to be repeated, while behavior that is ignored or not reinforced ultimately dies out.
Operant conditioning and classical conditioning became the foundation for behaviorism, though today it looks considerably different than it did in Skinner’s day. As the field evolved, practitioners came to recognize that factors other than environment – like disease, physical health, trauma, genetics, etc. – all have some influence over how people behave.
Most therapies in the field of behaviorism also emphasize the importance of cognitive processes, or the thoughts that lie behind our behaviors.
Exploring the Types of Behavior Therapies and Techniques
Today, behavior therapy is largely an umbrella term used to describe therapies that are focused on changing unwanted behaviors – often known as ‘shaping.’ Behavioral therapists may focus their work on one behavior therapy or technique, or they may apply a variety of therapies or techniques.
What links all behavior therapies is the goal of reinforcing desirable behaviors and eliminating unwanted ones.
The three most widely recognized behavior therapies include:
Cognitive Behavioral Therapy
Cognitive behavior therapy (CBT), which was first introduced by psychologists Albert Ellis (1950s) and Aaron Beck (1960s), is based on the notion that you can change your feelings by changing the thoughts and actions behind those feelings.
Through CBT, patients are taught to recognize these patterns of negative thoughts and actions and to learn how to alter them. For example, a behavior therapist may help a patient deal with anxiety by replacing anxiety-inducing thoughts with relaxation and deep breathing exercises.
This goal-oriented, hands-on therapy is short-term, with most benefits experienced in about 12 to 16 weeks.
Applied Behavior Analysis Therapy
Applied behavior analysis therapy is the specific branch of behavior therapy that looks to the principles of behavior to solve a myriad of issues, with the overreaching goal of improving patients’ quality of life.
These days, it’s most commonly associated with treating autism spectrum disorder in children, since it is the only therapy recognized as effective in bringing positive change to the behavior patterns typical of kids with ASD. ABA has been proven effective in addressing things like a lack of verbal communication skills, lack of empathy, obsessive focus in a single topic, and stimming (hand flapping and rocking).
The process of ABA, in its simplest form, involves teaching appropriate behaviors while reducing or eliminating negative or problematic ones using a system of feedback and rewards.
ABA therapists treat patients using a variety of techniques focused on helping patients learn or relearn behaviors through the mastery of simple steps that result in some positive reinforcement. The patient masters each step and then moves on to the next one, with steps gradually increasing in complexity.
The National Professional Development Center on Autism Spectrum Disorder identifies 27 evidence-based strategies used in ABA therapy. Some of the more commonly used among these include:
- Pivotal response training
- Discrete trial training
- Cognitive behavioral intervention
- Task analysis
- Time delay
While ABA therapy has long been widely researched and used with patients with autism and other cognitive challenges, the practice has expanded significantly in recent years, with ABA therapists finding success with everything from ADHD to post-traumatic stress disorder to obsessive-compulsive disorder.
Dialectical Behavior Therapy
Dialectical behavior therapy (DBT) has become a widely accepted form of behavior therapy for patients with borderline personality disorders and for those with severe depression.
Through DBT, patients are encouraged to come to terms with their thoughts, feelings, and behaviors. Through the validation process, patients learn to accept those thoughts and feelings so they can then begin to manage them. A plan of recovery is then designed and implemented that involves learning and practicing methods of coping with unhealthy thoughts.
Much of DBT involves introducing and practicing these coping strategies.
The Role of Behavior Therapists
Behavior therapists use one or more therapies and techniques to achieve behavioral improvement for their patients. Behavior therapists use talk therapy to achieve specific patient goals. It’s common for behavioral therapists to integrate a variety of behavior therapies and approaches, adapting strategies for each patient.
While direct patient care is the major job of behavior counselors, these professionals also:
- Conduct initial and ongoing patient assessments to determine the best courses of treatment
- Develop and modify individual treatment plans
- Follow prescribed protocols for treatment
- Record data regarding protocols and patient progress
- Communicate and collaborate with other members of the medical team regarding patient treatment
- Communicate with parents, caregivers, and client regarding treatment
Meeting the Requirements to Practice Behavioral Therapy
Behavior therapy is within the purview of a number of different types of counselors and therapists, so the path to becoming a behavior therapist can look quite different depending on educational goals, professional titles, professional certification, employer settings, and more.
Some of the professions that use some form of behavior therapy include:
- Behavior Analyst / ABA Therapist
- School Psychologist
- Behavior Interventionist
- Behavior Clinician
- Behavioral Consultant
- Early Education Therapist
Of course, full authority psychologists are required to hold a doctorate and licensure through a state board of psychology, giving them the legal authority to prescribe and implement behavioral therapy, and certainly some training in conventional methods.
School psychologists and any other counselor or behavioral specialist working in a school setting will need to meet state and district specific certification requirements required of anybody working for the school system.
In the case of both doctorate-prepared psychologists and master’s-prepared behavior specialists and counselors working in schools, many of the standard steps toward meeting license requirements overlap with the standard requirements for earning the Board Certified Behavior Analyst (BCBA) credential through the Behavior Analysis Certification Board.
This means that anybody who is just getting started and working towards the goal of eventually becoming a licensed psychologist or working in a school setting can follow a path that is virtually the same as that of an independent applied behavior analyst. This would allow them to develop the skills necessary to specialize in ABA en route to achieving other professional goals.
For example, if your ultimate goal is to become a psychologist, you’ll have to earn a PhD or PsyD… but along the way, you could earn a master’s in psychology that includes the curriculum requirements for BCBA certification.
Earning BCBA certification requires:
- Earning a master’s degree in behavior analysis (or in education or psychology with an emphasis in ABA) that includes the BCBA Verified Course Sequence
- Meet the supervised experience hour requirement with an intensive practicum of 750 hours, OR standard practicum of 1000 hours, OR 1,500 hours of independent fieldwork
- Pass the BCBA certification exam and become certified (required for licensure in some states)
- In some cases, applying for state ABA licensure is also necessary to provide ABA services. In many states, BCBA certification is either required for licensure (currently required in 30 states), or is otherwise one route to meeting the requirements for licensure.
The Behavior Analyst Certification Board (BACB) also offers a doctoral level credential for anybody who meets the above-noted requirements with a doctorate: Board Certified Behavior Analyst-Doctoral (BCBA-D).
Educational Requirements to Become a Behavior Analyst
Many in the field of behavior therapy work exclusively as applied behavior analysts in specialized ABA clinics or other settings, rather than ABA being ancillary to a primary role as a psychologist or school-based behavior therapist. In this case, the process is straightforward and simply requires you to meet the requirements for national certification through the Behavior Analysis Certification Board and any state licensing that might be required where you plan to work.
Even though a master’s degree in behavior analysis, education, or psychology with an ABA emphasis is the standard educational requirement for becoming a Board Certified Behavior Analyst, you do have options if you already hold a master’s that doesn’t include the required mix of board-approved ABA courses, known as the Verified Course Sequence (VCS).
If you already have a master’s degree in one of these areas or even another field, you’ll find lots of schools offer graduate certificates or post-master’s stand-alone VCS programs specifically designed to meet the requirements for BCBA certification. These programs may be offered on-campus, online, or through a blended course of study, and many can be completed on a part-time basis.
In some states, such as Alabama, Hawaii, Massachusetts, and Virginia, BCBA certification is a requirement for licensure. However, even among states that don’t require BACB certification for licensure and in states that don’t license behavior analysts at all, BCBA certification is a widely respected and often required credential among employers.
Salaries for Behavior Therapists
Narrowing down the earning potential for behavior therapists involves casting a wide net since a variety of professionals provide behavioral therapy services.
The U.S. Bureau of Labor Statistics (BLS) provides a closer look at what these professionals earned at the 25th, 50th, 75th, and 90th percentiles, as of May 2021:
- Counselors, all others: $37,060, $45,160, $58,090, $76,780
- Clinical and Counseling Psychologists: $62,040, $82,510, $126,590, $167,460
- Special Education Teachers, All Other: $48,350, $61,720, $82,230, $104,370
- Educational, Guidance, and Career Counselors and Advisors: $47,390, $60,510, $77,210, $98,190
2021 US Bureau of Labor Statistics salary and employment figures for Counselors, all others; Clinical and Counseling Psychologists; Special Education Teachers, All Other; and Educational, Guidance, and Career Counselors and Advisors reflect national data, not school-specific information. Conditions in your area may vary. Data accessed January 2023.