Behavior analysts and counseling: Why are we not there and how can we get there?

Abstract

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 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 analysis. Thus, I hold two credentials: I am a board certified analyst (BCBA) as well as a licensed psychologist (LP). The BCBA signifies that I understand (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 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 analytic perspective. I came away with the sense that, with a few exceptions, analysis continues to avoid addressing some of the issues that traditional psychology and address. This is apparent even in the way behaviorists talk about between the two divisions of the field: one goes to a psychologist or counselor for or counseling; one receives from a behavioral psychologist or analyst (Baker, Blumberg, Freeman, & Wieseler, 2002; Dougher & Hackbert, 2000). Even for a single individual working as a BCBA and an LP, the two 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 services are provided with data sheets and a graph the are not compensated: insurance companies do not pay for behavior modification or intervention--they pay for and therapy. Thus, I feel that an understanding of the dichotomy between behavioral intervention and is critical to increasing the availability of quality analytic and is worthy of discussion. In my experience, while our unwillingness to foray into counseling areas is multivariate, there are a few basic areas that are fundamental to this unwillingness. First, because our education does not include psychological training, analysts do not learn how to present intervention in such a way as to receive third party reimbursement. Consequently, the contingencies that operate on our as we provide treatment for challenging 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 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 analysts, we receive our professional recognition (social reinforcement) from the community within which we operate. …