Behavior Therapy

Behavioral therapy is one of four psychotherapy approaches covered by statutory health insurance in Germany (so-called “guideline-based approaches”). The other three are analytical psychotherapy, depth psychology-based psychotherapy, and systemic therapy.

The basic idea stems from learning theory. People learn behaviors throughout their lives, and what has been learned can also be changed. Here, “behavior” refers not only to visible actions, such as outbursts of anger or avoiding certain situations, but also to feelings, thoughts, motives, and evaluations.

Behavioral therapy addresses specific, current problems. The focus is less on early childhood and more on what triggers a behavior in the here and now and what sustains it. For children and adolescents, it is the most commonly used treatment method covered by insurance guidelines. A nationwide analysis of individuals with public health insurance aged 0 to 19 showed that 56.7 percent received behavioral therapy, compared to 35.2 percent who received depth psychology therapy and 9.5 percent who received psychoanalysis. Health insurance covers up to 80 hours of treatment for behavioral therapy.

The process begins with behavioral analysis. The therapist and the child work together to identify the triggers that cause a behavior and the consequences that maintain it. For example: A child avoids school; the anxiety subsides temporarily, and that is precisely what reinforces the avoidance.

Based on this, several tools are used:

• Reinforcement: Desired behavior is specifically rewarded so that it occurs more frequently. Reward schedules and praise are part of this.
• Exposure: The child approaches an anxiety-provoking situation step by step, with guidance and in small doses. More information on this can be found under exposure therapy.
• Practice in Daily Life: Between sessions, the child and family are given tasks to try at home. Behavioral therapy relies on active participation and helping people help themselves.

For younger children, parents and other caregivers are closely involved. Structured parent training programs have been developed and studied for this purpose.

Classical behavioral therapy initially focused heavily on observable behavior and its triggers. Later, thinking came more into play—that is, cognitions such as internal evaluations, rumination, or self-doubt.

This evolution gave rise to cognitive behavioral therapy (CBT). It combines behavioral therapy techniques with work on distressing thought patterns. In practice, the line between the two is blurred, and many professionals today use the term “behavioral therapy” as an umbrella term that includes the cognitive components.

More advanced approaches, such as Acceptance and Commitment Therapy (ACT), also belong to this family. For parents, the exact classification is rarely decisive. What’s more important is that the chosen method is a good fit for the child and the condition, and that the therapist explains the approach to the family. If you’re unsure which approach is being offered, feel free to ask during the initial consultation whether and how the therapist works with thoughts.

Behavioral therapy is used to treat a range of mental health issues. Common areas of application include anxiety disorders, depression, obsessive-compulsive disorder, and eating disorders. It is also used to address addiction issues and physical symptoms such as chronic pain or sleep disorders.

For children and adolescents, treatment is tailored to their developmental stage. Instead of lengthy conversations, playful, hands-on, and creative methods are often used. Because problems usually manifest in the social environment, family, school, and daycare are all included in the diagnosis and treatment.

For parents, this means they are an active part of the treatment, not just observers. Often, during parent consultations, they learn how to react less strongly to crises at home and how to consistently reinforce desired behavior. For example, a child with compulsions practices in therapy how to resist the urge to act on them, while the parents learn to stop reinforcing the ritual by helping out. If necessary, behavioral therapy is combined with other components, such as in a multimodal therapy approach that includes psychotherapeutic, educational, and, in some cases, pharmacological elements. There is no guaranteed cure, but there are well-researched treatment approaches for many disorders.

If symptoms persist for weeks, interfere with your child’s daily life, or repeatedly lead to conflicts and withdrawal, a professional evaluation is advisable. The pediatrician is often the first point of contact. For psychotherapy, an initial consultation and a few trial sessions to get to know each other will take place before the actual treatment begins and a claim is submitted to the health insurance provider.

Parents can be involved in the treatment of children and adolescents as primary caregivers, as can, in some cases, teachers or caregivers who regularly interact with the child.

Important Note: Rückenwind offers coaching and support for parents, but not psychotherapy or diagnostic services. Janike is a social worker and parent coach currently in training to become a child and adolescent psychotherapist and is not licensed to practice medicine. A diagnosis and the decision regarding behavioral therapy are the exclusive responsibility of a child and adolescent psychiatry (KJP) specialist or a medical or psychotherapeutic professional.