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The Private Practice of Behavior Therapy a Guide for Behavioral Practitioners APPLIED CLINICAL PSYCHOLOGY Series Editors: Alan S

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The Private Practice of Behavior Therapy a Guide for Behavioral Practitioners APPLIED CLINICAL PSYCHOLOGY Series Editors: Alan S The Private Practice of Behavior Therapy A Guide for Behavioral Practitioners APPLIED CLINICAL PSYCHOLOGY Series Editors: Alan S. Bellack, Medical Callege af Pennsylvania at EPPl, Philadelphia, Pennsylvania, and. Michel Hersen, University af Pittsburgh, Pittsburgh, Pennsylvania Recent Volumes in this Series BEHAVIORAL ASSESSMENT AND REHABILITATION OF THE TRAUMATICALLY BRAIN DAMAGED Edited by Barry A. Edelstein and Eugene T. Couture COGNITIVE BEHAVIOR THERAPY WITH CHILDREN Edited by Andrew W. Meyers and W. Edward Craighead HANDBOOK OF BEHAVIORAL GROUP THERAPY Edited by Dennis Upper and Steven M. Ross ISSUES IN PSYCHOTHERAPY RESEARCH Edited by Michel Hersen, Larry Michelson, and Alan S. Bellack A PRIMER OF HUMAN BEHAVIORAL PHARMACOLOGY Alan Poling THE PRIVATE PRACTICE OF BEHAVIOR THERAPY Sheldon J. Kaplan RESEARCH METHODS IN APPLIED BEHAVIOR ANALYSIS Issues and Advances Edited by Alan Poling and R. Wayne Fuqua SEVERE BEHAVIOR DISORDERS IN THE MENTALLY RETARDED Nondrug Approaches to Treatment Edited by Rowland P. Barrett SUBSTANCE ABUSE AND PSYCHOPATHOLOGY Edited by Arthur I. Alterman TREATING ADDICTIVE BEHAVIORS Processes of Change Edited by William R. Miller and Nick H. Heather A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual ship­ ment. For further information please contact the publisher. The Private Practice of Behavior Therapy A Guide for Behavioral Practitioners Sheldon J. Kaplan Private Practice Jacksonville, Florida Plenum Press • New York and London Ubrary of Congress Cataloging in Publication Data Main entry under title: Kaplan, Sheldon J. The private practice of behavior therapy. (Applied clinical psychology) Bibliography: p. Includes index. 1. Behavior therapy-Practice. 2. Behavior therapy. I. Title. II. Seri~. (DNLM: 1. Behavior Therapy. 2. Private Practice-organization & administration. WM 425 K178p] RC489.B4K34 1986 616.89'142'068 86·12197 ISBN-13: 978-1-4684-5076-7 e-ISBN-13: 978-1-4684-5074-3 DOl: 10.1007/978-1-4684-5074-3 © 1986 Plenum Press, New York Softcover reprint of the hardcover 1st edition 1986 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher To my wife, Harriett, and sons, Lee and Kevin, for their patience, love, and loyalty to me not only during the preparation of this text, but always. Preface 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. This book is the result of an idea that arose out of a chapter I wrote for Volume 17 of Progress in Behavior Modification, edited by Michel Her­ sen, Richard M. Eisler, and Peter M. Miller. Within this text, I have tried to pull together not only all the pertinent behavioral literature I could find but also traditional clinical psychology and business literature as well. In this manner, the clinician can have a broad-spectrum look at establishing and maintaining a behavior therapy private practice. Chapter 1 presents a comparison of behavior therapy with clinical psychology as well as the advantages and disadvantages of a behavioral practice. Chapters 2 and 3 describe the methods for getting started and conducting the practice. Getting and "nurturing" referrals as well as the vii viii PREFACE methods for intake, assessment, treatment, and follow-up of a client are some issues in these chapters. Chapter 4 outlines and briefly discusses the various procedures from all areas of behavior therapy used in clinical practice, whereas Chapter 5 provides the therapist with the ethical standards and guide­ lines for professional services. Chapters 6 and 7 detail various "tools of the trade" such as recording and treatment forms, equipment, texts, computers, and continuing education. In Chapter 8, I discuss various issues relating to being a behavioral consultant to agencies, schools, retardation centers, and businesses. The growing influence of employment assistance programs, health mainte­ nance organizations, and preferred providers organizations provides a new market for short-term, effective treatment such as is available through behavior therapy. In Chapter 9, the "nuts and bolts" business issues of practice are discussed. Financially, "getting started" and "keeping going" one's prac­ tice is a never-ending challenge of monitoring expenses and minimizing overhead. On the other hand, developing quality services and earning a good reputation for such services will greatly offset overhead expenses to ensure that the practitioner "survives" as well as is financially com­ fortable in the public marketplace. Chapter 10 presents some case histories from my practice that exemplify the variety of clinical populations and problems served. In Chapter 11, I have provided the clinician with a discussion of several issues relating to the new directions in the field. Certification and licen­ sure, peer review, considerations of treatment regarding "setting events," and the influence of behavior therapy in the formulation of social policy are some examples. The intent of this text is to provide the beginning and practicing clinician with the basics of establishing and maintaining a behavior ther­ apy private practice. Though a variety of issues are discussed and high­ lighted in this book, the clinician must continue to rely on expertise, experience, and innovation, clinically and from a business standpoint. It is hoped that this guide will assist the clinician in this endeavor. Acknowledgments I would first like to thank Michel Hersen for suggesting the idea of a behavior therapy private practice text. I also express my thanks to Eliot Werner for giving me the opportunity to publish this volume with Plenum Press. There are many people who have contributed professionally to the work on which this book is based. I wish to thank my associate and friend, Stephanie D. Kuhling, for providing me with professional sup­ port and time in the exchange of ideas that have led to a successful and effective practice of behavior therapy. I wish to acknowledge also the support of the rest of my staff: Michael Sisbarro, Jennifer Glock, and Robert Woods. It is often said that without a highly competent office secretary and office manager, a business can not function. This is true in my office. With the calm persistence of my office manager, Denise Griggs, my office does run efficiently, smoothly, and in a very professional manner. My thanks to her as well. Finally, I wish to acknowledge the time, effort, and patience of my wife who read, proofed, and otherwise helped in the preparation of the manuscript, and to Lori Sistrunk and Lisa Hatcher for typing the manuscript. Ix Contents CHAPTER 1 BEHAVIOR THERAPY: FOUNDATIONS FOR CLINICAL PRACTICE ... 1 1.1. Definition of Behavior Therapy ........................ 1 1.2 Comparison of Behavior Therapy with Traditional Oinical Practice.............................................. 2 1.3. The Growing Influence of Behavior Therapy ............ 3 1.4. The Advantages and Disadvantages of a Private Practice in Behavior Therapy .................................. 4 CHAPTER 2 GETTING STARTED IN A BEHAVIOR THERAPY PRIVATE PRACTICE ............... 9 2.1 Getting Referrals ................................... _. 13 2.1.1. Indirect Methods .................................... _ 13 2.1.2. Direct Methods . .. .. 14 2.2. "Nurturing" Referrals: Keeping a Steady Flow .......... 16 2.3. Professional Services Offered by the Behavior Therapist .. 17 2.3.1. Individual Therapy ................................... 18 2.3.2. Behavior Group Therapy .............................. 18 2.3.3. Behavioral Evaluations ................................ 18 2.3.4. Parent Training ...................................... 19 2.3.5. Marital Therapy ...................................... 19 2.3.6. Sex Therapy ......................................... 19 2.3.7. Job-FindingTraining .................................. 19 2.3.8. Agency and Hospital Consultation ..................... 19 2.3.9. Business Consultations .................... " . .... 20 2.3.10. Biofeedback Therapy............................... ... 20 xi xii CONTENTS CHAPTER 3 CONDUCTING A PRIVATE PRACTICE IN BEHAVIOR THERAPy ........................ 21 3.1. General Comments ................................... 21 3.2. Procedural Concerns for the Provision of Behavior
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