Academic journal article The International Journal of Behavioral Consultation and Therapy

Behavior Analysts and Counseling: Why Are We Not There and How Can We Get There?

Academic journal article The International Journal of Behavioral Consultation and Therapy

Behavior Analysts and Counseling: Why Are We Not There and How Can We Get There?

Article excerpt

Behavioral psychology is a broad field that encompasses a range of topics from working with individuals with severe self-injurious behaviors through professional management in the workplace. While the range of topics is broad, the interventions or programs that are put into place have common elements: behaviorists work to modify behavior by using the principles of behavior.

The degree that I (the first author) hold is in developmental and child psychology, with my doctorate-level education focusing on behavior analysis. Thus, I hold two credentials: I am a board certified behavior analyst (BCBA) as well as a licensed psychologist (LP). The BCBA signifies that I understand behavior (or it should) while the LP indicates that I hold the credential necessary to bill insurance companies for my work with clients. I work with families and children that have behavioral challenges and continually come in contact with traditional views of the diagnosis, development, and treatment of emotional and behavioral challenges in children. Because of this, I attended a workshop on the treatment of emotional disorders in children at the most recent Association for Behavior Analysis International conference in order to further develop my understanding of the treatment of these disorders from a behavior analytic perspective. I came away with the sense that, with a few exceptions, behavior analysis continues to avoid addressing some of the issues that "traditional" psychology and counseling address. This is apparent even in the way behaviorists talk about services between the two divisions of the field: one goes to a psychologist or counselor for "therapy" or "counseling"; one receives "intervention" from a behavioral psychologist or behavior analyst (Baker, Blumberg, Freeman, & Wieseler, 2002; Dougher & Hackbert, 2000). Even for a single individual working as a BCBA and an LP, the two services are separate. When working with insurance companies, the language that is used determines if the service receives reimbursement: if "interactive therapy" with a descriptive narrative of what transpired during the psychologist/client interaction is provided the service receives compensation; if "intervention services" are provided with data sheets and a graph the services are not compensated: insurance companies do not pay for "behavior modification" or "intervention"--they pay for counseling and therapy. Thus, I feel that an understanding of the dichotomy between behavioral intervention and counseling is critical to increasing the availability of quality behavior analytic services and is worthy of discussion.

In my experience, while our unwillingness to foray into traditional "counseling" areas is multivariate, there are a few basic areas that are fundamental to this "unwillingness." First, because our education does not include traditional psychological training, behavior analysts do not learn how to present intervention services in such a way as to receive third party reimbursement. Consequently, the contingencies that operate on our behavior as we provide treatment for challenging behavior in an applied setting tend to be aversive--we either need to learn how to use non-behavioral terms to describe behavior/environment interaction (requiring an increased response effort) or we do not receive payment. A case in point is my recent experience with Medicaid. I had been supplying services for four families over a three-year period. When Medicaid conducted their audit of my files I was denied payment for these services, based in part on the type of notes I had (e.g. "change schedule of SR+ to a VR3"). Consequently, a recoupment process was started, and I was required to reimburse Medicaid the roughly $16,000 I had been paid over the three year period. This event was (and continues to be) quite punishing!

Secondly, as behavior analysts, we receive our professional recognition (social reinforcement) from the community within which we operate. …

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