Clinical behavior analysis: Where it went wrong, how it was made good again, and why its future is so bright. The Behavior Analyst Today, 3 3 , — Functional analytic psychotherapy: Creating intense and curative therapeutic relationships.
New York: Plenum Press. Functional analytic psychotherapy: A radical behavioral approach to treatment and integration.
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Journal of Psychotherapy Integration, 4 3 , — The dimensions of clinical behavior analysis. Behavior Analyst, 16 2 , — Functional analysis in behavior therapy. Hersen, R. Miller Eds. Roche, B. The Psychologist, 12 10 , — Schafer, R. A new language for psychoanalysis. Skinner, B. The operational analysis of psychological terms. Psychological Record, 52, — Science and human behavior.
New York: McMillian. Verbal behavior. New York: Appleton-Century-Croft. About behaviorism. New York: Knopf. Contrived reinforcement. The Behavior Analyst, 5, 3—8. Wachtel, P. Psychoanalysis and behavior therapy: Toward an integration.
A Guide to Functional Analytic Psychotherapy: Awareness, Courage, Love, and Behaviorism
New York: Basic Books. Holman What empirical evidence supports FAP?
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On the one hand, FAP is based on a handful of basic behavioral principles that were theoretically and empirically derived from decades of laboratory experimentation. On the other, FAP has yet to be tested in a randomized controlled trial. Our belief is that the basic tenets of FAP—namely the importance of the therapeutic relationship and the use of natural reinforcement to shape client problems when they occur naturally in the therapeutic relationship—are robust, and lines of evidence in support of these principles converge from multiple and diverse areas of research.
In this chapter we review these lines of evidence. It should be clear from the outset, however, that this review by no means seeks to justify the paucity of direct empirical evidence in support of FAP.
Rather, we believe that the findings of this review strongly suggest that additional empirical research specifically investigating the efficacy of FAP is warranted, as it was developed from a solid foundation of principles and evidence and represents a convergence of some of the most robust findings in psychological research. While FAP is a therapy based on behavior analytic principles, at its heart it is an interpersonal therapy. FAP is based on the assumption that both the causes of, and treatment for, psychopathology are intimately related to interpersonal relationships.
This assumption has substantial support in the literature with respect to depressive disorders. While several alternative therapies focus on the therapeutic relationship and associated processes, FAP utilizes basic learning principles to harness the therapist-client relationship, focusing on the establishment of a more effective D. Baruch et al. Several case studies of other interventions incorporating FAP have also been published. These reports provide anecdotal evidence and clinical guidance, and suggest the breadth of presenting problems for which FAP and FAP enhancements may be appropriate.
This abundance of case literature begs the question—what is the empirical basis of FAP? Our goal in this chapter is to highlight the converging lines of evidence from multiple disciplines that support key FAP principles. Concurrently, we note the ways in which FAP theory contributes to each of these literatures, and in doing so informs therapists about the promotion of client change using a unique and powerful methodology. To this end, we seek to address not only areas of convergence but also highlight where FAP diverges in either interpretation of findings or their implications for therapy.
The Therapeutic Alliance FAP is based on the notion that the therapeutic relationship is an important factor in psychotherapy—hardly a controversial notion. That is, what are the specific factors that make the therapist-client interaction curative? Before clarifying this position further, we first review the supporting evidence for the relevance of the relationship to psychotherapy.
Evidence for the importance of the therapeutic alliance emerges from two primary sources. Second, researchers unable to find a consistent difference in the effectiveness of psychotherapies across orientations e. Indeed, some researchers have even begun to argue that the quality of the alliance is more important than the type of treatment in predicting positive therapeutic outcomes e.
Although it is clear from the therapeutic alliance literature that the strength of the alliance is related to treatment outcome, there is evidence that many therapists fail to focus on the therapeutic relationship in-session. Similarly, Kanter, Schildcrout and Kohlenberg have shown that therapists in several studies of CBT for depression rarely focus on the therapeutic relationship for an extended period of session time. Perhaps the limited focus on the therapeutic relationship may be explained by the lack of consensus as to what therapists must do to secure a strong relationship, how much and what type of attention to pay directly to the therapeutic relationship, the mechanism underlying the relationship or its curative effect.
A Guide to Functional Analytic Psychotherapy : Awareness, Courage, Love, and Behaviorism
In contrast, a FAP conceptualization of in-session behavior would focus on how a particular behavior functions for the client, not whether it looks like alliance-type behavior. To investigate further the above point, imagine a behavior that appears topographically to be associated with alliance building in-session, but may in 24 D. What looks like alliance behavior in this case is actually a CRB1, an insession example of a problematic behavior such that he is not expressing a relevant feeling he is experiencing. On the other hand, if compliant behavior is assessed to be a CRB2 e.
The next three sections will review research findings corroborating these assumptions. Perhaps millions of pages of psychotherapy theory have been written about this topic, with the theoretical and empirical literature addressing the theory of transference perhaps the penultimate example.
Although the term transference hails from a different theoretical perspective, research on it nonetheless is relevant to FAP, as it provides support for the claim that CRB1s may be evoked by the therapeutic context. Until recently, transference remained a largely theoretical construct and underwent little empirical examination Connolly et al. Thus there is ample evidence supporting the claim that transference reactions occur in therapy. While this research is relevant to FAP, in that it corroborates the occurrence of CRBs, FAP and psychodynamic theory diverge with respect to the most effective response to transference reactions and CRBs see reinforcement contingencies and transference interpretations sections below.
For example, some therapists may argue that they reinforce client improvements when they provide praise e.
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FAP contends that such use of reinforcement would be more effective if provided at the same time and in the same place as the behavior it is intended to reinforce the client being assertive with her employer in the workplace. This belief underlies the focus on similar classes of behavior CRB2 emerging in the context of therapy that can be immediately reinforced.
What research supports this well-accepted maxim?
On one hand, literally thousands of studies have used immediate reinforcement to establish and maintain behavior. The human delay literature, while supportive of the above claim, is difficult to generalize to the psychotherapy situation. This is primarily because the lengths of 26 D. Reinforcement contingencies and their immediacy may be important in certain experimental situations or with discrete problems such as hair pulling, but are such issues relevant to adult, clinical populations dealing with abstract problems of intimacy, loneliness, anger, heartbreak, and so on?
Perhaps these concerns require something more sophisticated than simple contingencies of reinforcement. While both approaches believe in the power of the therapeutic relationship to produce change, FAP theory diverges significantly with respect to the claim from Rogerian theory that change may occur solely through non-directive or non-contingent therapist behavior. We would argue that a question to ask is whether non-directive or unconditional positive regard really is non-contingent.
People may be reinforced readily without awareness Frank, ; Krasner, , and thus a client may feel unconditional positive regard while being unaware of a contingent process. Two studies speak directly to this conditioning phenomenon.