“Behavioral Health” or “Psychotherapy”?

The new popular term for the kind of work I do as a psychotherapist seems to be “behavioral health.” This is a term often used by health insurance companies and, as a result, by agencies providing therapy services.

I don’t like it.*

What I don’t like about “behavioral health” is that it implies that psychotherapy is all about changing behavior. In my opinion, while behavior change is included in most people’s goals in psychotherapy, it is only a part of what psychotherapy is about.

I suspect that the emphasis on “behavior” originates with health insurance companies’ wanting to know that their money is being well-spent on improving clients’ health. Therefore, they insist that clients have “measurable, behavioral goals” on their treatment plans. These goals are things like “eat three meals per day” or “find gainful employment” or “reduce panic attacks to once a month or less.” There is nothing wrong with these goals. But, in my opinion, they are insufficient.

Yes, my psychotherapy clients want to be more functional and able to pursue their goals. But essentially, they want to feel content and at peace with themselves and the world. Contentment and peace are hard to measure. So often, therapists have to write treatment plans with goals like, “Client will report feeling content on most days of the week.” Because reporting is a way to measure how much you have improved the behavior of feeling content.

To me, this just seems silly. It demonstrates a problem with needing to get approval from insurance companies for psychotherapy: therapists have to change the way they describe their work. While it is nice to think that describing therapy as “behavioral health” is just a semantic change that doesn’t have to affect therapists’ approach with clients, I think our language does end up affecting our work. It subtly pushes therapists to focus on clients’ behaviors instead of focusing on how clients feel about themselves and their lives. This is fine for therapists who choose a mostly behavioral approach (which is a valid kind of therapy if that is what you choose to do).

As for me, I prefer the term “psychotherapy” to describe what I do. From Wikipedia:

Psychotherapy is an English word of Greek origin, deriving from Ancient Greek psyche (ψυχή meaning “breath; spirit; soul”) and therapia (θεραπεία “healing; medical treatment”).

Healing your spirit. Learning to breathe again. Healing your soul. That is what I think of when I think of psychotherapy. Changing behavior is a part of this healing. But just because we “behave” in a “healthy” manner (whatever that is) doesn’t mean we are at peace, able to breathe, or able to have spirited lives.

Healing the spirit is a really big goal. I’m not sure that we can completely achieve that goal in our lifetimes. My goals as a psychotherapist are to help clients with some of their healing, to allow them to renew their souls and have space in their lives to breathe. My hope is that we all find people in our lives to help us with those goals.

  1. * I am not the only one who has wondered about the use of “behavioral health.” See, for example, this post from the Psychology Today website. []

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