What is a Behavioral Therapist?
A behavioral therapist practices behavioral therapy which focuses on peoples’ behaviors rather than their underlying unconscious motivations and emotions. This therapy operates from the theory that since all behavior is learned, unhelpful and damaging behaviors can be unlearned.
The most common and best-known behavioral therapy is cognitive behavioral therapy which focuses on understanding the relationship between a person’s thoughts and feelings and how those thoughts and feelings influence and affect behaviors. If you change the thought, you can change the behavior.
A behavioral therapist is a mental health professional, licensed and experienced in conducting this type of therapy. It can take years of training and experience to become a behavioral therapist.
What Does a Behavioral Therapist Do?
A behavioral therapist works in clients individually, in groups, and in communities in a variety of settings. During sessions, the therapist encourages clients to discuss their feelings, lives, and behaviors.
They discuss how unwanted behaviors are adversely affecting a client’s life and help clients to change those behaviors. How a behavioral therapist does this is often tied to a therapist’s orientation and experience.
General Tasks Across Orientations
Some clinical tasks are the same regardless of the therapist’s orientation. All therapists must conduct an intake evaluation to determine diagnosis. Therapists must also form a collaborative working relationship with the client in order to work effectively toward goals. Then therapists must track progress toward goals. Finally, therapists must help determine when to end therapy.
Even within the umbrella of behavioral therapy, there are a number of types of therapeutic subdivisions that will color what a therapist will choose to do within a course of therapy.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapists work from the belief that thoughts and emotions are connected to the behaviors that a client chooses to engage in. This is a type of “talk” therapy in which the client and the therapist talk about the client’s issues and behaviors and seek out ways to change unwanted behaviors.
The therapist and client form goals in the initial phase of treatment. For example, if the ultimate goal is to alleviate depression, some of the supportive goals may be to understand a client’s negative thoughts which affect such behaviors as choosing to stay in bed, using alcohol or other substances to mask emotional pain, and ultimately, to choose behaviors instead that will move a client toward their goal of alleviating their depression.
Systematic Desensitization
This type of therapy is particularly helpful for phobias. A therapist works with a client to remove their fear response to a particular stimulus such as flying, leaving the house, or the like, substituting a relaxation response when confronted with the fear inducing stimulus.
A therapist works with the client to establish a hierarchy of fears, with less fearful stimuli at the bottom and the most fearful stimulus at the fop of the list. Once this is accomplished, the therapist and client work to establish a set of relaxation techniques that the client will use when facing escalating fears, starting with the easier fears, and building their way to the most fearful activity on their list.
These techniques can include breathing techniques, meditation, yoga, and the like. The third step involves using these techniques in conjunction with relaxation techniques to change the fear response in the client.
Aversion Therapy
In aversion therapy, the therapist couples an unpleasant stimulus with the behavior that that the client seeks to change. Most often used with addictive behaviors such as alcohol or drug use, the therapist and client decide on an appropriate negative stimulus that will be administered every time the client engages in the behavior.
For example, if the client wants to stop drinking alcohol, the negative stimulus is often a drug that induces nausea and vomiting. Every time the client drinks, the medication causes severe discomfort.
Over time, the client learns to associate drinking alcohol with stomach upset and stops the behavior. Other types of negative stimuli include electric shock, snapping an elastic band on the wrist when engaging in negative thoughts or actions, and the like.
The therapist begins by assessing the circumstances in which the undesirable behavior arises and how it affects the client. The therapist and client work to establish a good working relationship which is conducive to a positive outcome. The therapist chooses the type of negative stimulus to be used. A positive therapeutic relationship helps the client stick with the aversion therapy until the goal is achieved.
Why Do We Need Behavioral Therapists?
Behavioral therapy is a targeted shot-term therapy, often from 5 to 20 sessions and is often covered by medical insurance. This type of approach is quite effective at changing unwanted behaviors.
Behavioral therapists are expert at working specifically with thoughts and feelings in relation to behaviors, and work particularly well with a number of targeted issues such as: Depression, Anxiety, Phobias, PTSD, ADHD, Substance Abuse, and Eating disorders.
What are the Requirements to Become a Behavioral Therapist?
Educational Requirements
At a minimum, a person who wants to become a behavioral therapist will need a master’s degree in psychology or counseling and licensure in the state in which they want to practice. Many behavioral therapists hold doctoral degrees
Whether at the master’s or doctoral level, most programs will include a combination of formal classes and internships. Formal classes may cover such things as theory, psychopharmacology, working with minorities, substance abuse issues, cultural diversity, and treatment planning.
Internships usually occur at school approved external sites. A student will provide client treatment under the direct supervision of under a licensed supervisor and supervision may be in group or individual form.
A master’s program takes two to three years to complete and will include at least one year of internship. A clinical doctoral program usually results in either a PhD in counseling or a PsyD in counseling. Therapists seeking an advanced degree usually, opt for the PsyD program.
Doctoral programs can take 4 or more years to complete depending on whether a student enrolls full or part-time. PsyD requirements include between 70 and 124 semester units or their quarter unit equivalents.
Courses can include advanced psychological testing, advanced psychopathology, lifespan development, child development, research methods, practicum, and supervision.
Licensure and Certification
After formal education is completed, all states require that a candidate be licensed according to the rules of that state. Licensure exams are stringent and difficult.
In addition, yearly continuing education is required by most licensing boards. States have differing hourly requirements. Specializing in any type of therapy requires ongoing training post licensure.
There are some certification programs available for people who wish to specialize in behavioral therapies. Cognitive-behavioral therapy certifications are available through the National Association of Cognitive-Behavioral Therapists. The Behavior Analyst Certification Board also certifies individuals as Board Certified Behavior Analysts (BCBA).
What Do You Learn in a Behavioral Therapist Degree Program?
Learning to become a therapist involves a combination of knowledge-based skills and practical hands on experience with clients over time. Therefore, all advanced degrees in counseling include both knowledge-based courses and supervised practicums. The following is a partial list of areas covered in an advanced degree.
Theories and Orientation
All therapists need to study and experience varying theoretical orientations in their clinical studies and practicums. There are many such orientations, including behavioral therapy.
Other types of orientations include psychodynamic, client centered, existential, and others. Therapists eventually gravitate toward one or more of these orientations and that will dictate how they conduct therapy with a client.
Testing and Assessment
Psychologists use psychological testing and assessment to determine diagnosis and to guide treatment in many cases. There are a number of testing tools available such as: a typical IQ test, the Rorschach inkblot test, the Strong Inventory, and others. A therapist learns about testing tools and how to administer and use them to help a client.
Crisis Management
Suicidality and homicidally are two of the most common types of crises that clients can face. Other crises can include child abuse and elder abuse. A therapist must learn when and how to intervene to keep the client and others safe when a crisis hits.
Treatment Planning
A treatment plan is individually crafted for each client. A treatment plan will usually include such things as: diagnosis, client demographics, measurable goals, and goal tracking methodology. To some extent, treatment planning is guided by a therapist’s particular orientation. This is an important skill.
Legal and Ethical Responsibilities
All therapists have both legal and ethical duties and responsibilities to their clients and to society at large. A therapist receives confidential information from clients each time a therapist sits with a client. Understanding the limits of confidentiality and apprising a client of those limits is one of the most basic legal and ethical duties a therapist owes.
Most states also mandate that therapists are mandated reporters for child and elder abuse. A therapist must learn about the duties these laws impose upon them.
In addition, a therapist must be careful to maintain professional boundaries with clients. These boundaries include such things as not having a personal relationship with a client, ensuring that a therapist’s personal problems and issues do not invade or interfere with a client’s therapy, and obtaining professional consultation on professional issues that may arise during therapy with a client.
Theoretical Interventions
How a therapist chooses to conduct therapy, what interventions to use and when, are issues that often grow out of a therapist’s theoretical orientation.
A behavioral therapist will engage in different clinical interventions with a client than say, a psychodynamic therapist. As a therapist determines what orientation or orientations they will choose to use, the therapist will learn appropriate interventions under the guidance of a supervisor as part of their practicum.
Psychopharmacology
Psychopharmacology is the study of what mental health medications do and how they work. While most behavioral therapists will not be able to prescribe medications in the course of their practice, it is important to learn how a client’s medications will affect their mental, emotional and physical health.
Counseling Skills and Techniques
Some counseling skills and techniques remain a constant across theoretical orientation. Intake assessment, crisis management, forming a therapeutic bond with the client, creating a safe space for the client, are all important therapeutic skills. Many of these skills are learned during practicum.
What Skills are Needed to be a Behavioral Therapist?
Behavioral therapists require certain skills in order to do the job well, help their clients, and maintain appropriate boundaries with clients. The job is a complex one as clients come into therapy seeking help with problems that they have been unable to solve on their own.
- Empathy: Empathy is the most important skill that a therapist must have. It is critical to be able to understand a client’s experiences and feelings from their point of view. Empathy is a skill that can be developed over time.
- Listening Skills: Along with empathy, a therapist must learn to listen carefully and deeply to what a client is saying in the room with the therapist. Equally important, but often overlooked, a therapist must also become adept at determining what the client is not giving voice to in the sessions. This information can be as important if not more important than what the client articulates.
- Boundaries: Without a safe space, it is impossible for a client to delve into personal issues deeply. Boundary setting and maintaining boundaries is critical to developing a safe space for the client. It is a building block to trust. Some boundaries are obvious. It is important to avoid a close relationship with a client. Others are less obvious. It is important that a therapist learn to keep their own issues, prejudices, and personal life out of the therapeutic space.
- Critical Thinking: While a therapist is sitting empathetically with a client, the therapist is also tracking how the client’s discussion relates to their diagnosis and how to help steer the client toward choices that relate to the client’s goals. This requires a type of duality on the part of the therapist that contains a large critical thinking component.
- Problem Solving: Ultimately, a therapist is an adept problem solver. A good therapist must be adept at helping the client keep moving toward their goals even when the client is experiencing resistance toward the achievement of those goals, all the while making sure the client feels heard and understood.
- Interpersonal Skills: Therapists are highly skilled at making a client feel comfortable. They learn how to engage a client and help a client delve deeply into their problems. These are interpersonal skills that move far beyond conversational skills and are learned in working directly with clients under supervision.
- Attention to Detail: Attention to what a client says during a session, and from session to session is an important skill. In some ways, this is a tracking skill, but therapists must track information on a deeper level than most people. Therapists must also learn to track this information in regard to a client’s goals and the therapeutic timeline for the therapy as a whole.
- Patience: A therapist must maintain patient at all times. A client must never be lectured, and part of the therapeutic process requires that the therapist honor the client’s journey and experience in therapy. Real change only happens when the client makes the changes in a supported way and that usually takes time and diligent work.
What are the Pros of Being a Behavioral Therapist?
Job Satisfaction
Most therapists go into the field to help people and therapists innately want to help. It is highly satisfying to engage with clients on their journey toward better mental and m=emotional health. The bond between a therapist and a client is also a very satisfying relationship. Although limited in scope to just the therapy, the relationship is deep and is based on trust.
Flexible Work Schedule
In many settings, a therapist will have the ability to set much of their own schedule. They set their own appointments with clients. If a therapist works in a clinic or hospital setting, a therapist will often have other duties such as staff meetings to vary their daily work routine.
New Challenges
With new clients come new challenges. Each client is unique, and each client’s problems are unique. Thus, no two therapies are ever identical. This can be an invigorating environment for a person who gets bored easily.
Good Earnings
As of December 2022, according to ZipRecruiter, the average salary of a cognitive behavioral therapist is $60,657 per year, with top earners (90th percentile) making on average $94,500 per year.
What are the Cons of Being a Behavioral Therapist?
Stressful Work
Working with clients can be difficult work though it can be highly rewarding. Client s experience real psychological pain that they divulge to the therapists. In therapy, empathy requires that a therapist join with their clients in feeling and understanding their clients’ experiences, and that can be stressful.
Erratic Schedules
A therapist in private practice has an ever-changing client load. As clients come and go, a therapist’s schedule is rarely the same from week to week and that can make a therapist’s schedule and income feel erratic from time to time.
Billing Stresses
Billing takes time and patience. No matter the setting, all therapy must be documented, and billing is part of that process. For a therapist billing private insurance, Medicare, or Medicaid, all the proper billing codes must be used for each bill submitted. This can tack on quite a bit of time to the end of a therapist’s day.
Length and Expense of Education
All post bachelor education is expensive. Whether a therapist is involved in a master’s or doctoral program, the cost of an advanced degree can exceed $50,000 for many schools. This expense coupled with years in school can be daunting to anyone considering therapy as a career.
What is the Job Outlook for Behavioral Therapists?
The Bureau of Labor Statistics predicts that behavioral therapists should see increasing job opportunities through 2031, due in part to an increase in the number of Americans who have medical insurance.
For those holding a bachelor’s degree, the job growth rate is 22% according to the BLS. This is much faster growth than the average. For those holding advanced degrees in therapy, the job outlook is expected to grow 6% through 2031 according to the BLS.
How Much Does a Behavioral Therapist Make?
As of December 2022, according to ZipRecruiter, the average salary of a cognitive behavioral therapist is $60,657 per year, with top earners (90th percentile) making on average $94,500 per year.
The states and districts that pay these professionals the highest mean salary are Nebraska ($76,599), California ($75,775), Texas ($71,151), Wyoming($70,716), and Arkansas ($69,811).
What Professions are Similar to Behavioral Therapist?
Marriage and Family Therapist (MFT)
A marriage and family therapist holds an advanced degree and is a licensed professional. An MFT works with individuals and families work through problems in personal and family relationships. Most MFTs hold a master’s degree.
Social Worker (LCSW)
A licensed clinical social worker works with clients in a variety of settings. Some social workers conduct therapy with clients, while many work to help clients build and maintain social networks to help a client live independently. A social worker often hooks a client to needed social services such as housing, food, therapy, and a variety of other needed services.
Health Educators
Like a social worker, a health educator works with individuals and communities to increase knowledge and awareness regarding behaviors that promote wellness. A health educator often helps individuals and communities find services or devise needed health and wellness services within their communities.
Psychiatrist
A licensed medical doctor, a psychiatrist specializes in mental health issues with clients. Although many psychiatrists choose to work only with clients seeking mental health medications, some psychiatrists provide their clients with mental health therapy. This position requires graduation from medical school and licensure.
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