What Does a Behavioral Therapist Do?

Behavioral therapists work with patients to identify, understand and treat difficult or unhelpful behaviors or thought patterns. They develop therapy strategies that can improve their patients' quality of life.

As defined by the American Psychological Association, behavior therapy focuses on “the behavior itself and the contingencies and environmental factors that reinforce it, rather than exploration of the underlying psychological causes of the behavior.”¹

Behavioral therapy techniques can help people of every age, race, gender identity and walk of life. They can be useful in treating diverse conditions, including:²

• Bipolar disorder
• Alcohol and substance use disorders
• Anxiety
• Attention-deficit/hyperactivity disorder (ADHD)
• Autism spectrum disorders
• Borderline personality disorder (BPD)
• Depression
• Eating disorders
• Panic disorder
• Phobias
• Obsessive-compulsive disorder (OCD)

 
Read on to explore the work of the behavioral therapist.

In writing for Orlando Health, Jesse Radloff, LMHC, noted, “At their core, behavioral therapies are action-oriented interventions that help you change an unhelpful behavior and increase a helpful one. This happens through repetition and activities that replace the old learning of unhelpful behaviors with new learning.”³

His article goes on to describe five types of behavioral therapy:³

“Classical conditioning pairs something neutral with something that provokes a response."³ Think of the Russian neurologist Ivan Pavlov’s dogs, who began associating a (neutral) bell with food (that provoked a response). This approach can help treat phobias and anxiety. When patients in a safe environment are slowly and repeatedly exposed to something they fear, they “unlearn” the fear response, which reduces their fear and anxiety. Classical conditioning can also be useful in treating substance abuse. When prescribed medications make a person ill upon using an abused substance, the person comes to associate that substance with feeling unwell.

In operant conditioning, rewards and punishments increase or decrease certain behaviors in order to teach a desired behavior. This is a common approach in teaching children at home and in school. In addition to rewards and punishments, other forms of operant conditioning include behavior contracts, time-outs and learning desired behaviors by seeing that other people who employ them enjoy positive outcomes.

The most common type of behavioral therapy, CBT, has many subtypes. The main idea is that unhelpful automatic thoughts can negatively affect human emotions, which drive human behavior. Since negative automatic thoughts don’t always reflect reality accurately, CBT interventions help patients recognize or change them and “manage how they perceive, interpret and react to the world.”³ CBT therapies are widely used in treating anger, anxiety, depression, eating disorders, panic disorders, phobias, substance abuse and trauma.

DBT therapy aims to help patients learn to regulate their emotions and develop healthy stress-management techniques. This highly structured form of behavioral therapy involves four essential components:⁴

• Mindfulness: learning to be more aware and remain in the present moment; this promotes acceptance as patients observe their thoughts, feelings and actions without judgment
• Distress tolerance: learning to cope with challenging situations and emotional pain, accepting them for what they are and letting go of what one thinks they should be
• Emotional regulation: learning to identify specific emotions in the moment, control them and express them in healthy ways
• Interpersonal effectiveness: learning to improve communication in relationships with others, clearly state one’s needs and set healthy boundaries

Chiefly used to treat borderline personality disorder, DBT can also help in the treatment of eating disorders, self-harming behaviors and substance abuse.

This highly individualized approach uses intense, comprehensive observation of behavior, through which the therapist can understand what conditions cause and/or support unhelpful actions and determine which interventions will help change them. Reward and/or punishment techniques can help move the behavior in the preferred direction. After analyzing the results, the therapist can adjust the interventions as needed.

Most commonly associated with Autism Spectrum Disorders, ABA can also help adults and children with behavioral problems, and it’s sometimes useful in improving systemic workplace efficiency.

Behavioral therapists work with people who live with mental disorders or who are striving to overcome challenges or adjust behaviors. They help patients develop the skills and thought patterns that will help them overcome and/or replace unhealthy behaviors. They may treat patients in private practices, clinics, hospitals, schools, rehabilitation centers or detention facilities.

The responsibilities of the behavioral therapist include:⁵

• Assessing patient conditions
• Creating personalized therapy strategies and treatment plans
• Helping patients set and achieve goals related to behavior
• Fostering positive behavior
• Minimizing negative habits
• Monitoring patient progress
• Managing numerous behavioral intervention programs simultaneously
• When appropriate, updating the patient’s family on how treatment is progressing

These call on the therapist’s scientific, therapeutic, observational and diagnostic expertise, as well as compassion, strong interpersonal and communications skills, active listening skills and patience.

To pursue a career as a behavioral therapist, you need:

• A bachelor’s degree—ideally, in counseling, psychology, social work or a related field
• Relevant work experience, such as with a specific population (children with Autism Spectrum Disorder or ADHD, adults coping with substance abuse, and so on). You may be able to gain this experience through internships during your bachelor’s and/or master’s degree program
• A master’s degree in counseling, psychology, social work or a related field
• Professional certifications, required by some employers as verification of your competence in a behavioral treatment model
• Clinical licensure: To work in private practice, a behavioral therapist is required to hold licensure as a professional counselor, clinical social worker, psychologist, or specialist in another area

In writing for Psychology Today in 2022, clinical psychologist Andrea Bonior, Ph.D., cited five common barriers people experience when seeking help with their mental health:⁶

1. Finances. Therapy isn’t usually available without some charge, and insurance coverage is typically partial, but not full.
2. Fear. Working on personal matters with a stranger can be daunting for anyone.
3. Feeling underrepresented. Finding a therapist who fully understands one’s unique experience and background can be a long process.
4. Loss of control over problems. The prospect of discussing things long kept private leads some people to dread feeling worse before feeling better.
5. Schedules and time commitment. Life is busy. The thought of carving an hour out of each week’s standing commitments to work and family can be a deal-breaker.

The process of treating behavioral problems in young people comes with several additional challenges. In multiple surveys, the adolescents receiving treatment, their parents and the therapists involved have cited these significant barriers to treatment:⁷

• Adolescents: negative staff attitudes, recurring changes in staff, long waits prior to their treatment, and the strength of the relationship between the therapist and adolescent
• Parents: family beliefs and attitudes toward treatment, the reality of treatment not meeting expectations, issues regarding access to treatment, and how negatively the parents’ stress was affected by the treatment of their child
• Therapists: adolescent adherence to treatment, the severity of presented problems, adolescent and parent perception, lack of family networking and support, treatment access difficulties, and parental stress and demands

The efficacy of behavioral therapy depends on factors including the condition being treated and the specific type of treatment used. When treating adolescents and teens, behavioral therapy:⁴

• Provides specific, identifiable skills
• Promotes mental flexibility and the ability to cope when under stress
• Helps regulate and modify unproductive, challenging or maladaptive patterns of thought
• Improves interpersonal and communication skills
• Improves functioning; provides better quality of life

MyLife Psychologists is a practice of psychologists and clinical psychologists based in Sydney, Australia. Their practitioners work with adolescents, individual adults and couples, and their website lists these benefits of cognitive behavioral therapy:⁸

1. It gives people hope. People seeking mental health care often feel pessimistic about the future. Behavioral therapy can help them see that our thoughts are not always accurate and open their minds to new possibilities.
2. It helps develop self-esteem. Many mental health conditions are associated with low self-esteem, which perpetuates the cycle of negative thoughts influencing behavior and behavior influencing thoughts. Behavioral therapy can break this pattern and help people build confidence in their abilities.
3. It can help people relax. As people learn to control their responses to their symptoms, they can develop calmer responses by using relaxation techniques.
4. It develops more rational thought processes. By questioning and replacing negative thoughts, we can transform our thought processes, coming to think rationally and evaluate appropriate responses to challenges.

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