Dr. Cristina Davis
If you are wondering what a Child Behavioral Therapist is and what they do, you are reading the right article. The question of what they do comes down to the school of thought they were trained under and the approach they use in therapy.Now, it is important to differentiate that there are two types of behavioral therapists. Applied Behavior Analysis (ABA) therapists work primarily with individuals with developmental disabilities, often with children, but not always.
Many mental health therapists or counselors may have a behavioral focus as well, however, their training while in school may have been different than that of an ABA therapist due to the mental health orientation that is found in many therapist and counselor training programs.
For the purpose of this article, “Behavioral Therapist” from this point forward will be in regard to those that have been trained in mental health and received a degree in this area and have more of a behavioral focus than other therapists.
Often, therapists that work with children have a more behavioral focus than other therapists. There may be many reasons for this. One reason may be that depending on the age, children may have a much less expansive vocabulary and may not get as much out of talk therapy as an adult. However, their behavior can be modified with a behavioral approach.
There are various other reasons as well. For instance, children may have less insight, their abstract thinking may be less developed, and frankly, children have difficulty sitting still for an extended time which is often an expectation in the typical private-practice, office setting.
What does behaviorally focused treatment look like?
Initially, therapists will often start with an intake which is an opportunity for them to meet the patient, interview the patient to understand the reason for why therapy is being sought and collect information about the patient’s history, and note behavioral observations. If the patient is a child, the parents are often there as well.
However, in the state of Washington, if a child is thirteen years of age or older, they are allowed to consent for mental health treatment without parental consent so sometimes, parents may be present, and other times, they may not be. Often, a therapist may request that the parent be present, if possible because a thirteen-year-old may not be able to answer all the questions that the therapist may ask.
Next, the therapist will develop a treatment plan with goal(s), interventions to target the challenging behaviors, and specified objectives to accomplish throughout the course of treatment.
The length of treatment may depend on various factors such as the severity of the presenting problem; the willingness of parents or guardians to participate in treatment; consistency of attending therapy; completion of homework outside of therapy; implementation of strategies at home; willingness of the parents to follow-through with consequences when necessary; communication between parents and therapist; and the therapist’s ability to develop a rapport with the child, just to name a few.
During the next few sessions, the therapist may continue to collect more information and develop a therapeutic rapport with the child. In addition, they will implement interventions during the sessions and often provide homework to the child as well as the parents so behavior can continue to be modified when not in therapy, which will provide additional information to discuss during therapy and treatment can be adjusted, as needed.
The therapist may want to teach the parents skills that can help them contribute to their child’s behavior change. The therapist may also introduce parents to terms like positive and negative, reinforcement, punishment, verbal praise, and consequences, however, the terms may not be what one might initially think of when they hear these terms.
For instance, positive and negative refer to adding or taking something away. Reinforcement means anything that, when applied, is likely to increase the likelihood that a behavior will re-occur and continue in the future. Punishment means anything that will likely decrease the chances of a particular behavior recurring in the future.
Verbal praise can be used as a type of reinforcer as it may increase the likelihood that a behavior will occur again in the future and can help to develop a stronger bond between children and parents. The therapist will likely help the parents become more effective in using verbal praise.
Although a “Good job” is verbal praise, it is much less effective than it could be, but it can be changed to be more effective. Consequences from a behavioral standpoint means anything that follows the behavior itself and does not necessarily have a negative connotation.
How can a child therapist help modify your child’s behavior?
Therapists can be helpful in a variety of ways. One of the most obvious ways that therapists can be helpful is by identifying what may be at the root of the child’s behavior as well as other important factors that may be contributing to the issue and developing appropriate interventions to manage and change the behavior.
In addition, therapists can help the parents learn to regulate their own responses when their child is engaging in undesirable behavior. Often, parents may attend to minor misbehaviors when it may be more effective and require less energy from the parents if they were to disengage. However, this requires being strategic and the therapist may likely ask about changes observed, areas that continue to need improvement, etc.
Since parents know their children best and spend much more time with their children than the therapist will, it is important that the parents become proficient in using the same strategies for tackling challenging behaviors at home.
The therapist will help parents learn and implement behavioral strategies to begin to shape their child’s behavior including implementing short-term and long-term incentives and following-through so that the desired behaviors are reinforced, and the undesired behaviors are minimally reinforced and will hopefully decrease over time. In addition, a therapist with a focus on behavioral interventions will help parents consider appropriate consequences that are proportionate to the undesired behavior and to follow-through when necessary.
Sometimes a concern that is identified in therapy is parents may give their child consequences that are disproportionate to the undesired behavior. Similarly, another concern sometimes identified in therapy is providing tangible incentives that are disproportionate to the desired behavior. For instance, if the child cleans their room once, and the parents take the child on a $500.00 shopping spree, this would be an example of an incentive that is disproportionate to the behavior.
Although it is exciting that the child is doing what is desired of them, remember that whatever is used to reinforce the behavior may be expected again the next time a desired behavior or task is completed. When considering appropriate incentives, ask yourself if this is proportionate, reasonable and if it is even within your means to provide it every time the child completes the behavior or desired task.
Also, consider using shared special time as an incentive like during your next family movie night, reward your child by allowing them to pick the movie or plan a picnic at the park and play with your child at the playground afterwards. These sorts of activities can be utilized to reinforce your child’s behavior of completing the desired task, but can also help develop a stronger relationship with them.
How can a behavioral approach help?
A behavioral approach can help with a variety of concerns. Tantrums, refusal to follow directions, refusal to complete chores or do homework, and more serious concerns such as destroying property or hurting others. Whatever the target behavior may be, the therapist will likely measure it throughout the therapy process to ensure progress is being made.
Tough pill to swallow.
Parents may have to recognize areas that they themselves may need to develop, practice and mature. Often, parents may have difficulty effectively regulating their own emotions when their child is distressed; frequently focus their attention onto their child’s minor misbehaviors; and/or lack attending enough to their child when they are doing well or are engaging in seemingly neutral behaviors.
These can be important considerations for a child’s ongoing behavioral issues as children almost always desire their parents’ attention, and if children do not get enough of it when they are doing well, they may seek it out another way.
Ultimately, the overall unspoken rule of therapy is that the child will become less and less dependent on the therapist to maintain the therapy gains, and the skills that the therapist uses with the child are transitioned onto the parents or guardians so that effective behavior change will be long-lasting and transitioning out of therapy will go smoothly.
If you are thinking you would like a counselor with a behavioral approach to work with your child, consider calling today at (206) 388-3929 and scheduling them for a risk-free initial session with me.
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