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Functional analytic psychotherapy

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Functional analytic psychotherapy (FAP) is a psychotherapeutic approach based on radical behaviorism that uses the therapeutic relationship as a means to maximize clinical change. Specifically, FAP suggests that in-session contingent responding to client target behaviors leads to significant therapeutic improvements.

FAP was first conceptualized in the 1980’s by Drs. Robert Kohlenberg and Mavis Tsai who, after noticing a clinically significant association between client outcomes and the quality of the therapeutic relationship, set out to develop a theoretical behavioral model of psychotherapy based on these concepts. Radical behavioral principles (e.g., reinforcement, generalization) form the basis of FAP [1][2](see The Five FAP Rules).

FAP is an idiographic approach (as opposed to a nomothetic approach) to psychotherapy. This means that FAP therapists  focuses on the function of a client’s behavior instead of the form. This allows the FAP therapist and client to change a broad class of behaviors that might look different on the surface but all serve the same function. It is idiographic in that the client and therapist work together to form a unique conceptualization of the client’s therapeutic goals (rather than one therapeutic target for every client who enters therapy). There are exceptions to this (see The ACL Model below). 

Basics

FAP posits that client behaviors that occur in their outside interpersonal relationships (i.e. the “real world”) will, given a therapeutic relationship of sufficiently high quality, occur in the therapy room as well. With this, FAP therapists, in collaboration with their client, develop a case conceptualization that includes classes of behaviors (based on their function not their form) that the client wishes to increase and decrease.

In-session occurrences of a client’s problematic behavior is called clinically relevant behavior 1 (CRB1). In-session occurrences of improvements is called clinically relevant behavior 2 (CRB2). The goal of FAP therapy is to decrease the frequency of CRB1’s and increase the frequency of CRB2’s.

The FAP therapist evokes (i.e. sets the context for) CRBs and gradually shapes CRB2s as they occur as a response.

The Five Rules operationalize the FAP therapist’s behavior with respect to this goal. It is important to note that The Five Rules are not rules in the traditional sense of the word, but instead a set of guidelines for the FAP therapist.

  • Rule 1: Watch for CRBs – the therapist focuses their attention on the occurrence of CRBs that are in-session problems (CRB1s) and improvements (CRB2s)
  • Rule 2: Evoke CRBs – the therapist sets a context which evoke the client’s CRBs.
  • Rule 3: Reinforce CRB2s Naturally – the therapist reinforces the occurrence of CRB2s (in-session improvements), increasing the probability that these behaviors will occur more frequently.
  • Rule 4: Observe Your Impact in Relation to Client CRBs – the therapist assesses the degree to which they actually reinforced behavioral improvements by noting the client’s behavior subsequent behavior after Rule 3. This is similar to the behavior analytic concept of performing a functional analysis.
  • Rule 5: Provide Functional Interpretations and Generalize – the therapist works with the client to generalize in-session behavioral improvements to the client’s our-of-session relationships. This can include, but is not limited to, providing homework assignments.

Awareness, Courage, and Love

Researchers at the Center for the Science of Social Connection at the University of Washington are developing a model of social connection that is highly relevant to FAP. This model - called The ACL model - delineates important behaviors to social connection based on decades of scientific research (e.g., [3]).

  • Awareness (A) behaviors include paying attention to your own and the other’s needs and values within an interpersonal relationship.
  • Courage (C) behaviors include experiencing emotion in the presence of another person, asking for what you needs, and sharing deep, vulnerable experiences with another person in the service of improving the relationship.
  • Love (L) behaviors involve responding to one’s courage behaviors with attunement to what that person needs in the moment. These include providing safety and acceptance in response to a client’s vulnerability.

FAP has the potential to target awareness, courage, and love behaviors as they occur in session as described by The Five Rules above. More research is needed to confirm the utility of The ACL Model [4][5].

Research support

Radical behaviorism and the field of clinical behavior analysis have very strong scientific support. [6] [7] Additionally, researchers have conducted a number of case studies [8][9][10][11] [12][13][14] [15][16][17], component process analyses [18][19] [20][21][22], study with non-randomized design on FAP-enhanced cognitive therapy for depression [23] and randomized control trial on FAP-enhanced acceptance and commitment therapy for smoking cessation [24]

Third generation behavior therapy

FAP belongs to a group of therapies referred to as “third-generation behavior therapies”(i.e. “third-wave behavior therapies) that includes Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), Behavioral Activation (BA), and Integrative Behavioral Couples Therapy (IBCT).[25]

Criticism

FAP has received criticism for “being ahead of the data” [26]. Corrigan argues that FAP requires more empirical support than it has to justify its widespread use. There is also criticism of using The ACL Model as targets (e.g..[27] ) as it detracts from the idiographic nature of FAP.


Professional organizations

  • Association for Contextual Behavioral Science (ACBS) - Founded in 2005 (incorporated in 2006), the Association for Contextual Behavioral Science (ACBS) is dedicated to the advancement of functional contextual cognitive and behavioral science and practice so as to alleviate human suffering and advance human well being.[28]
  • The Association for Behavior Analysis International (ABAI) has a special interest group for practitioner issues, behavioral counseling, and clinical behavior analysis. ABAI has larger special interest groups for behavioral medicine. ABAI serves as the core intellectual home for behavior analysts.[29][30] ABAI sponsors two conferences per year – one in the U.S. and one international.
  • The World Association for Behavior Analysis offers a certification for clinical behavior analysis which covers functional analytic psychotherapy [1].

See also

References

  1. ^ Kohlenberg, R. J., & Tsai, M. (1991). Functional analytic psychotherapy: A guide for creating intense and curative therapeutic relationships. New York, NY: Plenum.
  2. ^ Tsai, M., Kohlenberg, R. J., Kanter, J. W., Kohlenberg, B., Follette, W., & Callaghan, G. (2009).A guide to functional analytic psychotherapy: Awareness, courage, love and behaviorism.New York, NY: Springer.
  3. ^ eis, H. T., & Shaver, P. (1988). Intimacy as an interpersonal process In: S. Duck (Ed.), Handbook of personal relationships(pp. 367–389). Chichester, England: Wiley & Sons.
  4. ^ Kanter, J. W., Holman, G., & Wilson, K. G. (2014). Where is the love? Contextual behavioral science and behavior analysis. Journal of Contextual Behavioral Science, 3(2), 69–73.
  5. ^ Haworth, K. Kanter, J.W., Tsai, M. Kuczynski, A. M., Rae, J. R., Kohlenberg, R. J. (2015) Reinforcment matters: A preliminary, laboratory-based component-process analysis of functional analytic psychotherapy's model of social connection. Journal of Contextual Behavioral Science. http://dx.doi/org/10.1016/j.jcbs.2015.08.003
  6. ^ Kazdin, A. E. (2001).Behavior modification in applied settings(6th ed.). Belmont, CA: Wadsworth.
  7. ^ Catania, A. C. (1998). Learning. Upper Saddle River, NJ: Prentice Hall
  8. ^ Baruch, D. E., Kanter, J. W., Busch, A. B., & Juskiewicz, K. (2009). Enhancing the therapy relationship in acceptance and commitment therapy for psychotic symptoms. Clinical Case Studies, 8, 241-257
  9. ^ Callaghan, G. M., Summers, C. J., & Weidman, M. (2003). The treatment of histrionic and narcissistic personality disorder behaviors: A single-subject demonstration of clinical effectiveness using functional analytic psychotherapy. Journal of Contemporary Psychotherapy, 33, 321-339
  10. ^ Carrascoso, F. J. (2003). Jealousy: A case of application of functional analytic psychotherapy. Psychology in Spain, 7, 88-98
  11. ^ Ferro, R., Valero, L., & Vives, M. C. (2006). Application of functional analytic psychotherapy: Clinical analysis of a patient with depressive disorder. Behavior Analyst Today, 7, 1-18.
  12. ^ Kanter, J. W., Landes, S. J., Busch, A. M., Rusch, L. C., Brown, K. R., Baruch, D. E., & Holman, G. I. (2006). The effect of contingent reinforcement on target variables in outpatient psychotherapy for depression: A successful and unsuccessful case using functional analytic psychotherapy. Journal of Applied Behavior Analysis, 39, 463-467
  13. ^ Kohlenberg, R. J., & Tsai, M. (1994). Improving cognitive therapy for depression with functional analytic psychotherapy: Theory and case study. Behavior Analyst, 17, 305-319.
  14. ^ Kohlenberg, R. J., & Vandenberghe, L. (2007). Treatment resistant OCD, inflated responsibility, and the therapeutic relationship: Two case examples. Psychology and Psychotherapy: Theory, Research, and Practice, 80, 455-465.
  15. ^ Lopez, F. J. (2003). Jealousy: A case of application of functional analytic psychotherapy. Psychology in Spain, 7, 88-98
  16. ^ Manos, R. C., Kanter, J. W., Rusch, L. C., Turner, L. B., Roberts, N. A., & Busch, A. M. (2009). Integrating functional analytic psychotherapy and behavioral activation for the treatment of relationship distress. Clinical Case Studies, 8, 122-138.
  17. ^ Wagner, A. W. (2005). A behavioral approach to the case of Ms. S. Journal of Psychotherapy Integration, 15, 101-114.
  18. ^ Busch, A. M., Kanter, J. W., Callaghan, G. M., Baruch, D. E., Weeks, C. E., & Berlin, K. S. (2009). A micro-process analysis of functional analytic psychotherapy’s mechanism of change. Behavior Therapy, 40, 280-290
  19. ^ Busch, A. M., Callaghan, G. M., Kanter, J. W., Baruch, D. E., & Weeks, C. E. (2010). The Functional Analytic Psychotherapy Rating Scale: A replication and extension. Journal of Contemporary Psychotherapy, 40, 11-19. doi:10.1007/s10879-009-9122-8
  20. ^ Callaghan, G. M., & Follette, W. C. (2008). Coding manual for the Functional Analytic Psychotherapy Rating Scale (FAPRS). Behavior Analyst Today, 9, 57-97
  21. ^ Kanter, J. W., Landes, S. J., Busch, A. M., Rusch, L. C., Brown, K. R., Baruch, D. E., & Holman, G. I. (2006). The effect of contingent reinforcement on target variables in outpatient psychotherapy for depression: A successful and unsuccessful case using functional analytic psychotherapy. Journal of Applied Behavior Analysis, 39, 463-467. Kanter, J. W., Ma
  22. ^ Landes, S. J., Kanter, J. W., Weeks, C. E., & Busch, A. M. (2013). The impact of the active components of functional analytic psychotherapy on idiographic target behaviors. Journal of Contextual Behavioral Science 2(1), 49-57. http://dx.doi.org/10.1016/j.jcbs.2013.03.004
  23. ^ Kohlenberg, R. J., Kanter, J. W., Bolling, M. Y., Parker, C. R., & Tsai, M. (2002). Enhancing Cognitive therapy for depression with functional analytic psychotherapy: Treatment guidelines and empirical findings. Cognitive and Behavioral Practice, 9, 213-229
  24. ^ Gifford, E. V., Kohlenberg, B. S., Hayes, S. C., Pierson, H. M., Piasecki, M. P., Antonuccio, D. O., & Palm, K. M. (2011). Does acceptance and relationship focused of functional analytic psychotherapy and acceptance and commitment therapy for smoking cessation.Behavior Therapy, 42(4), 700-715
  25. ^ Hayes, S., Masuda, A., Bissett, R., Luoma, J., & Guerrero, L. (2004). DBT, FAR and ACT: How empirically oriented are the new behavior therapy technologies? Behavior Therapy, 35, 35-54.
  26. ^ Corrigan, P. W. (2001). Getting ahead of the data: A threat to some behavior therapies. The Behavior Therapist, 24, 189-193
  27. ^ Darrow S. M., Follette W. C., (2014) Where׳s the beef?: Reply to Kanter, Holman, and Wilson, Journal of Contextual Behavioral Science. 3, 4, 265-268, http://dx.doi.org/10.1016/j.jcbs.2014.08.007.
  28. ^ Long, Douglas. "Contextual Behavioral Science (CBS)". ContextualScience.org. ACBS. Retrieved 30 October 2014.
  29. ^ Twyman, J.S. (2007). "A new era of science and practice in behavior analysis". Association for Behavior Analysis International: Newsletter. 30 (3): 1–4.
  30. ^ "The Licensing of Behavior Analysts: Protecting the profession and the public". Journal of Early and Intensive Behavior Intervention. 5 (2): 8–19. 2008. {{cite journal}}: Unknown parameter |authors= ignored (help)
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