Working with gifted individuals in therapy requires understanding that their exceptional abilities do not shield them from emotional or behavioral difficulties. In many cases, these challenges are directly connected to the way they experience the world. From a behavioral therapy perspective, the goal is not only to relieve emotional distress, but to observe how it manifests in actions, identify the triggers and consequences that maintain those behaviors, and teach new, more adaptive patterns that promote well-being.
Gifted students may struggle with anxiety, social withdrawal, excessive perfectionism, avoidance of complex tasks, or even disruptive behaviors. These patterns are not always obvious, as their high academic or verbal performance can mask the issues. At times, their behaviors are misinterpreted as arrogance, defiance, or immaturity, when in fact they are learned responses to an environment that may fail to stimulate or understand them.
In behavioral therapy, we begin with a functional behavior assessment: what does the child or adolescent do, when do they do it, in what context, and what do they gain or avoid by doing it? From there, interventions can include gradual exposure to anxiety-provoking situations, direct instruction in social skills through modeling and reinforcement, or routines that encourage emotional self-regulation. For example, perfectionism can be addressed using differential reinforcement, rewarding effort and timely decision-making rather than flawless outcomes. For social withdrawal, we might schedule small, progressive social goals, paired with debriefing and support to reduce fear of rejection.
These young people often feel misunderstood both at school and at home. That’s why involving families in treatment is crucial. Instead of focusing solely on what’s “wrong,” we can help parents recognize and reinforce strengths, avoid unintentionally rewarding avoidance or fear of failure, and adjust their expectations. A home environment where mistakes are accepted and effort is valued is particularly important for these profiles.
An example commented by Steven I. Pfeiffer is that of a gifted adolescent with borderline-like symptoms: self-injury, substance use, and a sense of hopelessness. The treatment followed a behavioral approach using Dialectical Behavior Therapy (DBT), a skills-based model grounded in cognitive-behavioral therapy. The sessions included homework, role-playing, and exercises for identifying and managing intense emotions. The success of this process wasn’t only due to the techniques used, but to the strength of the therapeutic relationship—an alliance built on authenticity, understanding, and the therapist’s attentive presence.
Beyond clinical work, prevention is essential. Not all gifted individuals are in crisis, but many can benefit from programs in social-emotional learning, mindfulness, conflict resolution, or bibliotherapy. Films and books can also serve as valuable tools for discussing emotions, identity, and coping strategies. Pfeiffer emphasizes that therapists should be proactive, not just reactive.
In behavioral practice, tracking progress is not optional—it’s integral. Therapists can use behavior logs, parent and teacher rating scales, and self-report tools to assess change. This helps determine what’s working, what needs to be adjusted, and when it’s time to conclude therapy.
Helping a gifted person through behavioral therapy means letting go of the idea that “if they’re so smart, they should be able to handle it on their own.” Like everyone else, their behavior is shaped by reinforcement, learning history, and context. When we offer them clear tools, consistent support, and an environment that validates their complexity without overprotecting them, their emotional and psychological growth can become as remarkable as their intellect.
