The Private Practice of Behavior Therapy

Entering a full-time private practice and forsaking the comforts of a regular paycheck was a difficult decision for me. Fortunately, I was able to begin my practice on a part-time basis in space rented from two physician friends. By using my behavior skills for self-management and organization, I was then able to help my practice grow so that, with some trepidation, I moved into a full-time practice. I have continued to maintain my practice according to the same ethical, professional, and business assumptions discussed in this book. One of the reasons for my writing this book is that, at the time I was beginning my practice, there was no one text that helped me begin or to explain what "nuts and bolts" issues I needed to consider. As my practice has grown, I continued to see a need for a resource text to help the beginning therapist get started. I decided to describe the assump­ tions, methods, and issues that I have used so as to present a discussion of timely issues relevant to the practice of behavior therapy.

1 Behavior Therapy: Foundations for Clinical Practice.- 1.1. Definition of Behavior Therapy.- 1.2 Comparison of Behavior Therapy with Traditional Clinical Practice.- 1.3. The Growing Influence of Behavior Therapy.- 1.4. The Advantages and Disadvantages of a Private Practice in Behavior Therapy.- 2 Getting Started in a Behavior Therapy Private Practice.- 2.1 Getting Referrals.- 2.1.1. Indirect Methods.- 2.1.2. Direct Methods.- 2.2. “Nurturing” Referrals: Keeping a Steady Flow.- 2.3. Professional Services Offered by the Behavior Therapist.- 2.3.1. Individual Therapy.- 2.3.2. Behavior Group Therapy.- 2.3.3. Behavioral Evaluations.- 2.3.4. Parent Training.- 2.3.5. Marital Therapy.- 2.3.6. Sex Therapy.- 2.3.7. Job-Finding Training.- 2.3.8. Agency and Hospital Consultation.- 2.3.9. Business Consultations.- 2.3.10. Biofeedback Therapy.- 3 Conducting a Private Practice in Behavior Therapy.- 3.1. General Comments.- 3.2. Procedural Concerns for the Provision of Behavior Therapy Services.- 3.3. Relationship Enhancement and Rapport Building.- 3.4. Initial Session.- 3.5. Assessment, Forms, and Procedures.- 3.6. Evaluation.- 3.7. Composition of the Therapy Hour.- 3.8. Homework Assignments, Client Compliance and Noncompliance, and Troubleshooting Problems in Therapy.- 3.9. Termination and Follow-Up.- 4 A Review of Common Treatment Procedures in Behavior Therapy.- 4.1. Treatment Procedures.- 4.2. Traditional Operant Conditioning/Behavior Modification Procedures.- 4.2.1. Positive and Negative Reinforcement and the Scheduling of Reinforcers.- 4.2.2. Shaping.- 4.2.3. Forward and Backward Chaining.- 4.2.4. Instructional Control.- 4.2.5. Graduated Guidance.- 4.2.6. Prompting and Fading.- 4.2.7. Reinforced Practice.- 4.2.8. Extinction.- 4.2.9. Punishment: Withdrawal of Positive Reinforcers.- 4.2.10. Punishment: Imposing Aversive Stimuli.- 4.2.11. Overcorrection.- 4.2.12. Minimeal Training.- 4.2.13. Token Economy.- 4.2.14. Behavioral Contracting.- 4.3. Classical Conditioning Procedures.- 4.3.1. Progressive Deep Muscle Relaxation Training.- 4.3.2. Systematic Desensitization.- 4.3.3. Assertiveness Training.- 4.3.4. Covert Sensitization.- 4.3.5. Covert Conditioning Procedures: Covert Reinforcement.- 4.3.6. Flooding, Response Prevention, and Implosion.- 4.3.7. Aversion Relief.- 4.4. Social Learning and Self-Control Procedures.- 4.4.1. Imitation and Modeling.- 4.4.2. Self-Control Methods.- 4.5. Cognitive Restructuring Procedures.- 4.5.1. Rational Emotive Therapy (RET).- 4.5.2. Cognitive Therapy.- 4.5.3. Thought Stopping.- 4.5.4. Stress Inoculation Training.- 4.5.5. Problem Solving and Impulse Control Training.- 4.6. Biofeedback and Physiological Reconditioning Methods.- 4.6.1. Electromyographic Training, Alpha Wave Training, Thermal Training, Electrodermal Training, and Blood Pressure and Heart Rate Training.- 4.6.2. Sensory Awareness and Autogenic Training.- 4.7. Concluding Comments.- 5 Professional Standards and Ethical Issues for Private Practice.- 5.1. Ethical Principles of Psychologists (APA, 1981).- 5.2. Standards for Providers of Psychological Services (APA, 1977).- 5.3. Specialty Guidelines for the Delivery of Services (APA, 1980).- 5.4. Ethical Issues for Human Services (AABT, 1977).- 5.5. Formulating a Written Service Delivery Plan: Pertinent Professional Questions.- 5.5.1. Flow Chart of Services.- 5.5.2. Professional Liability.- 6 Recording and Treatment Forms.- 6.1. Recording Forms.- 6.1.1. Treatment Plan Form.- 6.1.2. Session-by-Session Treatment Tracking Form.- 6.1.3. Session Summary Form.- 6.1.4. Data Collection and Homework Assignment Sheets.- 6.1.5. Motivation for Behavior Change Form.- 6.1.6. Termination and Follow-Up Forms.- 6.2. Treatment Forms.- 6.2.1. Traditional Behavior Modification Procedures.- 6.2.2. Pavlovian/Wolpean Procedures.- 6.2.3. Bandura’s Social Learning and Self-Control Methods.- 6.2.4. Cognitive Restructuring Procedures.- 6.2.5. Biofeedback and Physiological Reconditioning Forms.- 7 Supplementary Tools for Behavioral Practice.- 7.1. Equipment.- 7.1.1. Traditional Behavior Modification.- 7.1.2. Classical Conditioning Procedures.- 7.1.3. Social Learning Procedures.- 7.1.4. Cognitive Restructuring Procedures.- 7.1.5. Biofeedback Procedures.- 7.2. Books and Journals.- 7.2.1. Comprehensive Texts Encompassing All Fields of Behavior Therapy.- 7.2.2. Traditional Behavior Modification.- 7.2.3. Classical Conditioning Texts.- 7.2.4. Social Learning and Self-Control Texts.- 7.2.5. Cognitive Restructuring Texts.- 7.2.6. Biofeedback and Psychophysiology Texts.- 7.3. Continuing Education.- 7.4. The Use of Computers in a Behavioral Private Practice.- 7.4.1. Word Processing.- 7.4.2. Data Base Filing.- 7.4.3. Graphs and Charts.- 7.4.4. Spread Sheet Analysis.- 7.4.5. Testing Programs.- 8 The Behavior Therapist as Consultant.- 8.1. Issues and Current Directions in Behavioral Consultation.- 8.1.1. Appropriate and Functional Goals.- 8.1.2. Staff Management.- 8.1.3. Data-Based Decision Making.- 8.1.4. Quality Control.- 8.2. Behavior Consultation Settings.- 9 Business Concerns for the Behavior Therapist.- 9.1. The Decision to Enter Private Practice.- 9.2. Office Location and Furnishings, Layout, and Hours.- 9.3. Support Services.- 9.4. Other Initial and Ongoing Expenses.- 9.5. Fees: Setting, Collections, and Projections.- 9.6. Marketing Professional Services.- 9.7. Business Resources for the Private Practitioner.- 9.8. Pertinent Business Questions.- 9.9. Alternative Mental Health Care Delivery Systems: Threat or Opportunity for the Mental Health Practitioner?.- 9.10. HMOs.- 9.11. PPOs.- 9.12. EAPs.- 10 Case Illustrations from a Behavioral Practice.- 10.1. Billy: A Child Exhibiting Disruptive Behaviors.- 10.2. Paula: A Case of Persistent Hair Pulling (Trichotillomania).- 10.3. Robert: A Physically Aggressive Mentally Retarded Adult.- 10.4. Marie: A Case of Heterosexual Anxiety and Sexual Dysfunction.- 10.5. Jennifer: A Case of Depression with Medical Complications.- 10.6. Matt: A Case of Hypertension and Interpersonal Difficulties.- 10.7. Summary.- 11 Current Trends and Future Directions in the Practice of Behavior Therapy.- 11.1. Clinical Issues.- 11.1.1. The Least Restrictive Alternative Model.- 11.1.2. Appropriateness and Effectiveness of Treatment.- 11.1.3. Certification of Behavior Therapists or Behavior Therapy Procedures: Issues of Regulation of the Field.- 11.1.4. Peer Review and Human Rights Committees in the Public and Private Sectors.- 11.2. Applied Research Issues.- 11.2.1. Ecobehavioral Systems and the Analysis of Setting Events: A Study of More Complex and Subtle Social Contingencies.- 11.2.2. Research and Therapy: Toward a Better Integration of Disciplines.- 11.2.3. Scientific and Social Validation and Consumer Satisfaction: Research and Clinical Accountability.- 11.3. Behavior Therapists’ Role in Shaping Social Policy.- References.