Why psychologists and therapists should learn clinical behavior analysis

Why Psychologists and Therapists Should Learn Clinical Behavior Analysis

By Angela Coreil, PhD, LP, BCBA

One of the most surprising things I’ve learned after years of clinical practice is that becoming a better therapist wasn’t about learning another therapy. It was about learning the common language underneath them.

For Clinicians:

If you practice long enough, you’ll eventually encounter clients for whom there simply are no relevant randomized controlled trials. That’s not because our evidence-based treatments are inadequate. It’s because no randomized controlled trial could ever capture the complexity of the clients we actually see in practice.

The moment you begin combining diagnoses, developmental histories, medical conditions, family systems, cultures, learning histories, and environments, the number of possible combinations becomes enormous. No treatment manual could reasonably anticipate all of them. As clinicians, we’re then faced with a challenge. We still want to provide evidence-based care, but we also have to adapt that care to fit the individual sitting in front of us.

That means supervision, reading across literatures, and learning how to translate what “works” from one therapeutic language into another.

Over the years, I’ve trained extensively in Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Therapy (CBT), Functional Analytic Psychotherapy (FAP), Exposure and Response Prevention (ERP), and Prolonged Exposure (PE). I’ve trained less deeply in Compassion-Focused Therapy, Schema Therapy, and even spent some time learning psychodynamic approaches.

On the surface, these therapies often appear very different. They use different terminology, different conceptual models, different intervention strategies, and sometimes different assumptions about why people change.

Yet when you sit in a room with a client – what happens isn’t actually “ACT”, “CBT”, or any therapy name. At a very important level, all that ever occurs in those rooms is two people ‘behaving.’ Whether you’re doing exposure therapy, cognitive restructuring, metaphors, etc…. it is all words (vocal verbal behavior), body movements, and the like. Some of you are going to have your hackles up already. 

Calm those feathers down! I’m not discounting all or certain therapies. We simply forget that we can describe behavior and record BEHAVIOR without inferring that it means something else.  That doesn’t mean every therapy is “really behavior analysis”, nor does it mean that theoretical differences don’t matter. Rather, behavioral principles provide a common scientific language that allows us to understand, compare, and translate across treatment approaches.

In the most difficult cases I’ve treated, I rarely found myself abandoning evidence-based treatments. Instead, I found myself applying behavioral principles ideographically. The treatment remained evidence-based. The application became individualized. For me, that has been one of the greatest practical values of learning clinical behavior analysis.

For Researchers

Researchers face a different—but related—challenge. Psychotherapy research continues to evolve. Process-based therapy, for example, represents an important attempt to move beyond comparing therapy brands and toward understanding mechanisms of change. I think that movement is asking many of the right questions. At the same time, much of our research, and the process-based work, still depend on composite constructs. Those constructs become the variables that organize entire research programs. As our theories evolve, so do the constructs and the measures designed to assess them.

There is another way to think about this. Instead of moving toward increasingly complex constructs, we can also move toward increasingly behavioral measurement. What do I mean by that? Take a construct like anxiety sensitivity. Most anxiety researchers recognize that anxiety sensitivity has long been conceptualized as a combination of physiological reactivity and beliefs or expectancies about what those bodily sensations mean. 

Put simply, it is something like:

“My body reacts strongly, and that reaction means something bad is going to happen.”

I’m intentionally simplifying here—the anxiety sensitivity literature is much richer than that—but the point illustrates an important measurement issue. (Don’t flood with me with comments on how this is inaccurate. It’s an example). Instead of measuring only the composite construct, we could separately measure the components. We could directly measure physiological responding. (Yes, I know logistics, sensitivity, and specificity… again, example.) 

We could separately measure the individual’s verbal behavior about those experiences. When I say verbal behavior, I don’t necessarily mean only what someone ‘says’ in therapy. It includes the language we collect through questionnaires, ecological momentary assessment, interviews, natural language samples, and other forms of measurement. Rather than immediately treating those responses as indicators of an underlying construct, we can first view them simply as behavior worthy of analysis in its own right.

That shift changes the assumptions we make about our data. More importantly, it creates opportunities.

First, your research becomes more durable. If future researchers redefine anxiety sensitivity, develop a better measure, or propose a different construct altogether, your original behavioral observations remain useful. You still have the physiological data. You still have the verbal behavior. Those observations can be reorganized under future theories without losing the original information.

Second, keeping the raw behavioral observations allows us to ask questions that today’s theories may not even anticipate. As our methods improve – particularly in areas like ecological momentary assessment, passive sensing, and natural language processing – we may discover behavioral patterns that were hidden when everything was reduced to a single total score.

I suspect this will become increasingly important over the next few decades.

Clinical behavior analysis has become valuable to me because it gives me a common language for both clinical practice and research. As a clinician, it has helped me understand how to adapt evidence-based treatments without abandoning the evidence. As a researcher, it has changed how I think about measurement and the kinds of data I want to preserve for future analyses.

If those ideas interest you, follow along. Many of the future blogs on this site will explore how clinical behavior analysis can help us think more clearly about therapy, assessment, measurement, and the science of behavior.